Provider Demographics
NPI:1588320600
Name:GHAFARI, MASOMEH
Entity type:Individual
Prefix:
First Name:MASOMEH
Middle Name:
Last Name:GHAFARI
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 1:1055 CRESTA WAY APT 9
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4869
Mailing Address - Country:US
Mailing Address - Phone:510-604-9571
Mailing Address - Fax:
Practice Address - Street 1:1055 CRESTA WAY APT 9
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4869
Practice Address - Country:US
Practice Address - Phone:510-604-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95239662163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse