Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 52090 | CA |
NPI | 1053419739 |
---|---|
Provider Name | Setareh Mozafari-Nejad |
First Address | Menlo Park, CA 94025-6303 |
Second Address | Cupertino, CA 95014-3472 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 04/03/2013 |