Basic Information
| Provider Information | |||||||||
| NPI: | 1013646918 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMIRI | ||||||||
| FirstName: | ROHYA | ||||||||
| MiddleName: | KOHGADAI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 618 WATERFALL ISLE | ||||||||
| Address2: | |||||||||
| City: | ALAMEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945015648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109195270 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | MARIN COMMUNITY CLINICS | ||||||||
| Address2: | 411 4 TH STREET | ||||||||
| City: | SAN RAFAEL, CA 94901 | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154481500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2022 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 27867 | CA | Y | Dental Providers | Dental Hygienist |
No ID Information.