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General NPI Number Information
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NPI Number | 1871588913
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Entity Type | Individual
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Provider Name | FILOMENA BAJA KHODAYARI NP
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Gender | Female
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 320 LENNON LN
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City | WALNUT CREEK
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State | CA
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Zip | 94598-2419
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Country | US
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Telephone | 925-906-2345
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Fax |
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Provider Business Mailing Address
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Address Line | 320 LENNON LN
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City | WALNUT CREEK
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State | CA
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Zip | 94598-2419
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Country | US
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Telephone | 925-944-4956
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 392222
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License Number State | CA
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