=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861543092
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZAHRA SARA NADERI D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1539 E PLAZA BLVD SUITE A
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-3641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-474-1072
-----------------------------------------------------
Fax | 619-474-4653
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1539 E PLAZA BLVD SUITE A
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-3641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-474-1072
-----------------------------------------------------
Fax | 619-474-4653
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 50496
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------