Provider Demographics
NPI:1679796866
Name:HAFEZI, MARJAN (NP)
Entity type:Individual
Prefix:
First Name:MARJAN
Middle Name:
Last Name:HAFEZI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WHIPPLE AVE
Mailing Address - Street 2:#135
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2843
Mailing Address - Country:US
Mailing Address - Phone:650-366-5594
Mailing Address - Fax:650-366-6352
Practice Address - Street 1:2900 WHIPPLE AVE
Practice Address - Street 2:#135
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2843
Practice Address - Country:US
Practice Address - Phone:650-366-5594
Practice Address - Fax:650-366-6352
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15580363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner