Active NPI
Nazila Tazangi Edalati, DDS
- Dentist
- Vallejo, CA
National Provider Identifier
1073780722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 45852
- Practice address
- 475 Redwood St
30
Vallejo, CA 94590-2954 - Phone
- (707) 643-1714
- Fax
- (707) 643-8951
- NPI assigned
- May 13, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 45852 | CA | Primary |
Addresses
Primary practice location
475 Redwood St
30
Vallejo, CA 94590-2954
Mailing address
475 Redwood St
30
Vallejo, CA 94590-2954
Phone (707) 643-1714
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45852 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210636800000",
"number": "1073780722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 REDWOOD ST",
"address_2": "30",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945902954",
"telephone_number": "707-643-1714",
"fax_number": "707-643-8951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475 REDWOOD ST",
"address_2": "30",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945902954",
"telephone_number": "707-643-1714",
"fax_number": "707-643-8951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDALATI",
"first_name": "NAZILA",
"middle_name": "TAZANGI",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-13",
"last_updated": "2008-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "45852",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.