Healthcare Provider Details

I. General information

NPI: 1043902141
Provider Name (Legal Business Name): MARIAM JANZAD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1981 N BROADWAY STE 255
WALNUT CREEK CA
94596-3827
US

IV. Provider business mailing address

PO BOX 25583
PASADENA CA
91185-0001
US

V. Phone/Fax

Practice location:
  • Phone: 888-777-1945
  • Fax: 805-413-9099
Mailing address:
  • Phone: 805-505-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95019648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: