Individual
MISS SHARAREH DERAKHSHANDEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2425 SAMARITAN DR, SAN JOSE, CA 95124-3908
(408) 559-2011
Mailing address
2425 SAMARITAN DR, SAN JOSE, CA 95124-3908
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA18046
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA 18046
PHYSICIAN ASSISTANT
CA
Enumeration date
02/07/2008
Last updated
04/12/2022
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