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General NPI Number Information
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NPI Number | 1346648565
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Entity Type | Individual
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Provider Name | ROKHSAREH EYVAZKHANY
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Gender | Female
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 633 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10017-6706
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Country | US
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Telephone | 646-227-3654
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Fax |
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Provider Business Mailing Address
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Address Line | 9805 JAKE LN APT 14507
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City | SAN DIEGO
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State | CA
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Zip | 92126-3030
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Country | US
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Telephone | 973-270-4019
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 018302
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License Number State | NY
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