Provider Demographics
NPI:1174165583
Name:BARAHMANI, NAZILA (NP)
Entity type:Individual
Prefix:
First Name:NAZILA
Middle Name:
Last Name:BARAHMANI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 MISSION COLLEGE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1842
Mailing Address - Country:US
Mailing Address - Phone:650-325-6000
Mailing Address - Fax:650-325-8091
Practice Address - Street 1:2160 W GRANT LINE RD STE 210
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7333
Practice Address - Country:US
Practice Address - Phone:209-229-7245
Practice Address - Fax:209-229-7247
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012995363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty