Provider Demographics
NPI:1306543970
Name:JAFARISHOURIJEH, MOHAMMADREZA (FNP)
Entity type:Individual
Prefix:DR
First Name:MOHAMMADREZA
Middle Name:
Last Name:JAFARISHOURIJEH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:729 SUNRISE AVE STE 602
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4542
Mailing Address - Country:US
Mailing Address - Phone:916-953-7571
Mailing Address - Fax:916-771-8515
Practice Address - Street 1:2321 W MARCH LN STE 100
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5278
Practice Address - Country:US
Practice Address - Phone:209-921-3895
Practice Address - Fax:209-243-3472
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA2022010963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily