Healthcare Provider Details

I. General information

NPI: 1174045736
Provider Name (Legal Business Name): MOJGAN REZAEI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10371 N. ORACLE RD SUITE 101A
ORO VALLEY AZ
85737
US

IV. Provider business mailing address

10371 N ORACLE RD STE 101A
ORO VALLEY AZ
85737-9393
US

V. Phone/Fax

Practice location:
  • Phone: 520-505-1404
  • Fax:
Mailing address:
  • Phone: 520-505-1404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0981
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: