Healthcare Provider Details

I. General information

NPI: 1063998573
Provider Name (Legal Business Name): NAEIMA SANTANA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAEIMA JAFARIAN NASERIZAD

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24060 SE KENT KANGLEY RD
MAPLE VALLEY WA
98038-6801
US

IV. Provider business mailing address

3600 LIND AVE SW SUITE 100 ATTN CREDENTIALING
RENTON WA
98057-4970
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3522
  • Fax: 425-690-9522
Mailing address:
  • Phone: 425-690-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: