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Individual

ALEX REZA DAEISADEGHI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
3941 J ST STE 260, SACRAMENTO, CA 95819-3633
(916) 736-2323
(916) 736-0620
Mailing address
3400 DATA DR, RANCHO CORDOVA, CA 95670-7956

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
11004683
FL
363LA2200X
Adult Health Nurse Practitioner
Primary
95024987
CA

Other

Enumeration date
11/15/2019
Last updated
08/07/2023
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