Healthcare Provider Details

I. General information

NPI: 1174165583
Provider Name (Legal Business Name): NAZILA BARAHMANI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W GRANT LINE RD STE 210
TRACY CA
95377-7333
US

IV. Provider business mailing address

2804 MISSION COLLEGE BLVD STE 210
SANTA CLARA CA
95054-1842
US

V. Phone/Fax

Practice location:
  • Phone: 209-229-7245
  • Fax: 209-229-7247
Mailing address:
  • Phone: 650-325-6000
  • Fax: 650-325-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95012995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: