Active NPI
Tamana Mehdavi
- Nurse Practitioner
- Hayward, CA
National Provider Identifier
1629639984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 95010487
- Practice address
- 22331 Mission Blvd
Hayward, CA 94541-3911 - Phone
- (510) 471-5907
- NPI assigned
- Jun 26, 2019
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95010487 | CA | Primary |
Addresses
Primary practice location
22331 Mission Blvd
Hayward, CA 94541-3911
Mailing address
651 Folsom Ave # a
Hayward, CA 94544-6404
Phone (510) 789-7388
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561507200000",
"number": "1629639984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "651 FOLSOM AVE # A",
"city": "HAYWARD",
"state": "CA",
"postal_code": "945446404",
"telephone_number": "510-789-7388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22331 MISSION BLVD",
"city": "HAYWARD",
"state": "CA",
"postal_code": "945413911",
"telephone_number": "510-471-5907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEHDAVI",
"first_name": "TAMANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-26",
"last_updated": "2019-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "95010487",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hayward, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.