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General NPI Number Information
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NPI Number | 1730445644
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Entity Type | Individual
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Provider Name | NISREEN MESIWALA KOTHARI MD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 15051 HESPERIAN BLVD STE A
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City | SAN LEANDRO
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State | CA
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Zip | 94578
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Country | US
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Telephone | 510-276-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 250 KING ST UNIT 432
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City | SAN FRANCISCO
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State | CA
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Zip | 94107-5488
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Country | US
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Telephone | 248-760-9236
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | RS2014-0672
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 262309
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A144488
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License Number State | CA
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