Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A127973 | CA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A127973 | CA |
NPI | 1194086322 |
---|---|
Provider Name | Shireen N. Heidari |
First Address | Stanford, CA 94305-2200 |
Second Address | Stanford, CA 94305-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2012 |
Last Update Date | 19/07/2017 |