Healthcare Provider Details
I. General information
NPI: 1144214800
Provider Name (Legal Business Name): MAHTAB Z NEJAD DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1848 SARATOGA AVE BLD #1 SUITE #2
SARATOGA CA
95070-6612
US
IV. Provider business mailing address
1 CHARLES ST
LOS GATOS CA
95032-5471
US
V. Phone/Fax
- Phone: 408-866-5120
- Fax: 408-866-5005
- Phone: 408-866-5120
- Fax: 408-866-5005
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 111N00000X |
| Taxonomy | Chiropractor |
| License Number | DC25953 |
| License Number State | CA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: