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NPI Code Detail

MEDICARE: DR. NINA AMY MOHAZZAB D.D.S.

MEDICARE: DR. NINA AMY MOHAZZAB D.D.S.
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
1122300000XDentist100693CA

General Provider Information

NPI Number : 1548641772
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NINA AMY MOHAZZAB D.D.S.
Provider Business Mailing Address
First Line : 19502 VIA MONTE DR
Second Line :
City : SARATOGA
State : CA
Zip : 95070-4522
Country : US
Telephone Number : 408-460-9677
Fax Number :
Provider Business Practice Location Address
First Line : 3779 E CASTRO VALLEY BLVD
Second Line :
City : CASTRO VALLEY
State : CA
Zip : 94552-4835
Country : US
Telephone Number : 408-460-9677
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2015
Last Update Date : 10/20/2016

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