MEDICARE: DR. AZARM GHAREMAN PHD

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	103T00000X	Psychologist	PSY17003	CA

General Provider Information

NPI Number	:	1841358397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AZARM GHAREMAN PHD

Provider Business Mailing Address
First Line	:	1241 JOHNSON AVE PMB #118
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-3306
Country	:	US
Telephone Number	:	805-546-1190
Fax Number	:

Provider Business Practice Location Address
First Line	:	1241 JOHNSON AVE # 118
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-3306
Country	:	US
Telephone Number	:	805-546-1190
Fax Number	:

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	02/14/2011

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