Provider Demographics
NPI:1679751028
Name:KHANSHAGHAGHI, NILOOFAR (NMW)
Entity type:Individual
Prefix:
First Name:NILOOFAR
Middle Name:
Last Name:KHANSHAGHAGHI
Suffix:
Gender:F
Credentials:NMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 W 17TH ST
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3455
Mailing Address - Country:US
Mailing Address - Phone:714-500-0340
Mailing Address - Fax:714-500-0341
Practice Address - Street 1:1227 W 17TH ST
Practice Address - Street 2:SUITE # 101
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3455
Practice Address - Country:US
Practice Address - Phone:714-500-0340
Practice Address - Fax:714-500-0341
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1085163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator