Healthcare Provider Details

I. General information

NPI: 1871852012
Provider Name (Legal Business Name): ZAHRA NADERI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 INTERNATIONAL BLVD
OAKLAND CA
94601-2228
US

IV. Provider business mailing address

3649 GALLAGHER CIR
ANTIOCH CA
94509-5935
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number25592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: