Provider Demographics
NPI:1285014480
Name:PAKKHAH, ELNAZ
Entity type:Individual
Prefix:
First Name:ELNAZ
Middle Name:
Last Name:PAKKHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 MAHAILA AVE
Mailing Address - Street 2:F33
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5732
Mailing Address - Country:US
Mailing Address - Phone:720-226-1225
Mailing Address - Fax:
Practice Address - Street 1:3950 MAHAILA AVE
Practice Address - Street 2:F33
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5732
Practice Address - Country:US
Practice Address - Phone:720-226-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281998164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse