Healthcare Provider Details

I. General information

NPI: 1346993797
Provider Name (Legal Business Name): SAVANNAH MOHAZZABFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HAWTHORNE RD
SPOKANE WA
99251-3445
US

IV. Provider business mailing address

9504 NE 13TH ST
CLYDE HILL WA
98004-3445
US

V. Phone/Fax

Practice location:
  • Phone: 509-777-1000
  • Fax:
Mailing address:
  • Phone: 206-788-6924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: