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General NPI Number Information
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NPI Number | 1407458466
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Entity Type | Individual
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Provider Name | DIYORA MIRSAIDOVA PA
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Gender | Female
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 2633 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10025-5022
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Country | US
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Telephone | 212-321-7001
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Fax | 415-252-7176
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Provider Business Mailing Address
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Address Line | 1 EMBARCADERO CTR STE 1900
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-3723
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Country | US
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Telephone | 415-658-6791
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Fax | 415-520-0904
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 026456
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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