Provider Demographics
NPI:1669341921
Name:DEHDAR, FATEMEH
Entity type:Individual
Prefix:
First Name:FATEMEH
Middle Name:
Last Name:DEHDAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FARZANEH
Other - Middle Name:
Other - Last Name:DEHDAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1000 MAMBO WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4343
Mailing Address - Country:US
Mailing Address - Phone:510-305-1319
Mailing Address - Fax:
Practice Address - Street 1:1765 CHALLENGE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-5000
Practice Address - Country:US
Practice Address - Phone:916-905-5636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHM000786882471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography