Healthcare Provider Details

I. General information

NPI: 1912618844
Provider Name (Legal Business Name): ROKSANA KAZEMI DALIRI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 E CAPITOL EXPY
SAN JOSE CA
95121-2415
US

IV. Provider business mailing address

4103 VICTROLA DR
STOCKTON CA
95219-2046
US

V. Phone/Fax

Practice location:
  • Phone: 408-629-6060
  • Fax:
Mailing address:
  • Phone: 408-499-3447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number87347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: