Healthcare Provider Details

I. General information

NPI: 1508781907
Provider Name (Legal Business Name): HOMA ZARGHANI MIRZAZADEH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 AIRWAY DR
SANTA ROSA CA
95403-1670
US

IV. Provider business mailing address

5 OAK CREST CT
NOVATO CA
94947-4752
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-7750
  • Fax:
Mailing address:
  • Phone: 707-521-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number64348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: