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General NPI Number Information
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NPI Number | 1013646918
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Entity Type | Individual
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Provider Name | ROHYA KOHGADAI AMIRI
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Gender | Female
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Dates
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Enumeration Date | 06/07/2022
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | MARIN COMMUNITY CLINICS 411 4 TH STREET
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City | SAN RAFAEL, CA 94901
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State | CA
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Zip | 94901
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Country | US
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Telephone | 415-448-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 618 WATERFALL ISLE
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City | ALAMEDA
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State | CA
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Zip | 94501-5648
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Country | US
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Telephone | 510-919-5270
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 27867
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License Number State | CA
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