Siavash Rostami Jafarabad

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95020089 Issued in CA

Practice address

3076 Myrtledale Rd
Calistoga, CA 94515-1052

Phone

(707) 403-8529

NPI assigned

Mar 31, 2019

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 17, 2022.

{
    "created_epoch": "1553990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671235200000",
    "number": "1265993299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1170 STEINWAY AVE",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950086329",
            "telephone_number": "408-722-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3076 MYRTLEDALE RD",
            "city": "CALISTOGA",
            "state": "CA",
            "postal_code": "945151052",
            "telephone_number": "707-403-8529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSTAMI JAFARABAD",
        "first_name": "SIAVASH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-31",
        "last_updated": "2022-12-17",
        "certification_date": "2022-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95172675",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95020089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "SiaJaf123",
            "affiliation": "N",
            "endpointDescription": "SiaJaf12",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3076 Myrtledale Rd",
            "city": "Calistoga",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945151052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in Calistoga, CA
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.