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General NPI Number Information
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NPI Number | 1962064840
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Entity Type | Individual
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Provider Name | FATEMEH A TAVAKKOLY
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Gender | Female
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 1720 S BASCOM AVE
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City | CAMPBELL
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State | CA
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Zip | 95008-0608
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Country | US
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Telephone | 408-371-7191
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Fax |
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Provider Business Mailing Address
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Address Line | 15800 SHANNON RD
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City | LOS GATOS
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State | CA
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Zip | 95032-5724
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 60517
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License Number State | CA
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