Provider Demographics
NPI:1427117266
Name:NAHREINI, MITRA NAVVABEH (NP)
Entity type:Individual
Prefix:MISS
First Name:MITRA
Middle Name:NAVVABEH
Last Name:NAHREINI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MITRA
Other - Middle Name:NAVVABEH
Other - Last Name:NAHREINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:16773 BERNARDO CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2525
Mailing Address - Country:US
Mailing Address - Phone:858-705-2175
Mailing Address - Fax:
Practice Address - Street 1:16773 BERNARDO CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2525
Practice Address - Country:US
Practice Address - Phone:858-705-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 16122363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 16122OtherNURSE PRACTITIONER LICENS