Basic Information
| Provider Information | |||||||||
| NPI: | 1538657028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIRZAKHANI | ||||||||
| FirstName: | HANNAH | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 W 16TH ST | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195957585 | ||||||||
| FaxNumber: | 7195957589 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 W 14TH ST | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032705 | ||||||||
| CountryCode: | US | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2018 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C2-0023894 | DE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | TL.0007345 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.