Individual
VISTA S KHOSRAVI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
80 GREAT OAKS BLVD, SAN JOSE, CA 95119-1310
(408) 363-3000
Mailing address
1606 MONTELLANO CT, SAN JOSE, CA 95120-4833
(408) 927-9938
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G80120
CA
Other
Enumeration date
08/13/2006
Last updated
07/08/2007
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