MEDICARE: ROKHSAREH EYVAZKHANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	018302	NY

General Provider Information

NPI Number	:	1346648565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROKHSAREH EYVAZKHANY

Provider Business Mailing Address
First Line	:	9805 JAKE LN APT 14507
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-3030
Country	:	US
Telephone Number	:	973-270-4019
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-6706
Country	:	US
Telephone Number	:	646-227-3654
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2014
Last Update Date	:	07/13/2020

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Directions to “ ROKHSAREH EYVAZKHANY ” Practice Location

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