Provider Demographics
NPI:1427306158
Name:CASSIDY, MARZIEH MOHTASHAMI
Entity type:Individual
Prefix:
First Name:MARZIEH
Middle Name:MOHTASHAMI
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARZIEH
Other - Middle Name:
Other - Last Name:MOHTASHAMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255A S CAMINO DEL PUEBLO
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-5973
Mailing Address - Country:US
Mailing Address - Phone:505-867-2356
Mailing Address - Fax:505-867-2357
Practice Address - Street 1:255A S CAMINO DEL PUEBLO
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-5973
Practice Address - Country:US
Practice Address - Phone:505-867-2356
Practice Address - Fax:505-867-2357
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator