Healthcare Provider Details

I. General information

NPI: 1992933113
Provider Name (Legal Business Name): SYEEDA RAHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10737 CAMINO RUIZ SUITE 235
SAN DIEGO CA
92126-2359
US

IV. Provider business mailing address

11689 ASPENDELL DR
SAN DIEGO CA
92131-6109
US

V. Phone/Fax

Practice location:
  • Phone: 858-578-4220
  • Fax: 858-578-4417
Mailing address:
  • Phone: 858-695-1206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: