Healthcare Provider Details

I. General information

NPI: 1548055676
Provider Name (Legal Business Name): NELIA MOEZIZI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 TELEGRAPH AVE
OAKLAND CA
94609-2009
US

IV. Provider business mailing address

6097 ASHBURTON DR
SAN JOSE CA
95123-4402
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: