Healthcare Provider Details

I. General information

NPI: 1821606815
Provider Name (Legal Business Name): PARVA REZAI RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 76TH AVE SE APT 81C
MERCER ISLAND WA
98040-2728
US

IV. Provider business mailing address

1124 COLUMBIA ST
SEATTLE WA
98104-2026
US

V. Phone/Fax

Practice location:
  • Phone: 425-879-7696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86069478
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: