MEDICARE: TAHEREH SAZEGAR DNP, FNP

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	363L00000X	Nurse Practitioner	201909573NP-PP	OR
2	363LF0000X	Family Nurse Practitioner	95006854	CA

General Provider Information

NPI Number	:	1386184489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAHEREH SAZEGAR DNP, FNP

Provider Business Mailing Address
First Line	:	823 GATEWAY CENTER WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-4541
Country	:	US
Telephone Number	:	619-515-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2325 COMMERCIAL ST STE 1400
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-1195
Country	:	US
Telephone Number	:	619-515-2422
Fax Number	:

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

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	02/07/2025

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