Individual provider Active NPI

Laleh Rezaei-Homami, PNP

  • Pediatric Nurse Practitioner
  • Daly City, CA
National Provider Identifier
1104170844
Registry record updated Jun 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
95002540 Issued in CA
Practice address
901 Campus Dr Ste 111
Daly City, CA 94015-4930
Phone
(650) 652-8720
NPI assigned
Nov 2, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 95002540 CA Primary

Addresses

Primary practice location

901 Campus Dr Ste 111
Daly City, CA 94015-4930

Mailing address

325 Distel Cir
Los Altos, CA 94022-1408
Phone (650) 652-8720

Other practice location 1

725 Welch Rd
Palo Alto, CA 94304-1601
Phone (650) 497-8000

Other names 1

  • Laleh Rezaei Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161116002740 CA Practitioner - Nurse Practitioner 6204064132 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95002540CAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation Current Accepting new patients
County of San Mateo Current Accepting new patients
County of San Mateo CurrentSince Oct 15, 2018 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jun 8, 2020 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jun 8, 2020 Accepting new patients
County of San Mateo CurrentSince Oct 15, 2018 Accepting new patients
County of San Mateo CurrentSince Oct 15, 2018 Accepting new patients
Stanford Hospital and Clinics Past Accepting new patients
Sutter East Bay Medical Foundation Past Accepting new patients
Lucile Salter Packard Children'S Hospital at Stanford Past Accepting new patients

Locations

18400 US Highway 18
Apple Valley, CA 92307
Phone (760) 810-7590

901 Campus Dr
Ste 111
Daly City, CA 94015
Phone (650) 652-8720

901 Campus Dr
Daly City, CA 94015
Phone (650) 652-8290

1950 University Ave
Ste 160
East Palo Alto, CA 94303
Phone (650) 317-8100

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

1189 E Herndon Ave
Ste 103
Fresno, CA 93720
Phone (559) 450-7777

325 Distel Cir
Los Altos, CA 94022
Phone (510) 204-3977

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979

1555 East St
Ste 200
Redding, CA 96001
Phone (530) 229-0911

2710 Middlefield Rd
Redwood City, CA 94063
Phone (650) 364-6010

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 789-1505

3838 California St
Rm 410
San Francisco, CA 94118
Phone (415) 751-1847

123 S San Mateo Dr
San Mateo, CA 94401
Phone (650) 343-4200

222 W 39th Ave
San Mateo, CA 94403
Phone (415) 573-2222

3883 Airway Dr
Ste 220
Santa Rosa, CA 95403
Phone (707) 521-7750

10200 Trinity Pkwy
Ste 101
Stockton, CA 95219
Phone (209) 323-3488

550 S Green Valley Rd
Watsonville, CA 95076
Phone (831) 458-5865

Interoperability endpoints

  • Direct secure messaging: lrezaeihomami19476@smch.direct-ci.com
  • Direct secure messaging: lrezaeihomami396166@hisp.ehr.sutterhealth.org

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592438400000",
    "number": "1104170844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408",
            "telephone_number": "650-652-8720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 CAMPUS DR STE 111",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940154930",
            "telephone_number": "650-652-8720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "725 Welch Rd",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "943041601",
            "country_code": "US",
            "telephone_number": "650-497-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REZAEI-HOMAMI",
        "first_name": "LALEH",
        "name_prefix": "Ms.",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-02",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "95002540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LALEH",
            "last_name": "REZAEI",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Daly City, CA

Sources for this page

Verify at the official NPI Registry.