MEDICARE: MRS. SHIRLEY CHRISTINE MIRZAIAN MS RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	974811	CA

General Provider Information

NPI Number	:	1700048659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHIRLEY CHRISTINE MIRZAIAN MS RD

Provider Business Mailing Address
First Line	:	2155 VERDUGO BLVD # 406
Second Line	:
City	:	MONTROSE
State	:	CA
Zip	:	91020-1628
Country	:	US
Telephone Number	:	818-522-9851
Fax Number	:

Provider Business Practice Location Address
First Line	:	2155 VERDUGO BLVD # 406
Second Line	:
City	:	MONTROSE
State	:	CA
Zip	:	91020-1628
Country	:	US
Telephone Number	:	818-522-9851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	01/07/2015

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