Healthcare Provider Details

I. General information

NPI: 1447243886
Provider Name (Legal Business Name): THOMAS MIRZAI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 E BELL RD 4400
PHOENIX AZ
85032-2122
US

IV. Provider business mailing address

3815 E BELL RD 4400
PHOENIX AZ
85032-2122
US

V. Phone/Fax

Practice location:
  • Phone: 602-788-7211
  • Fax: 602-788-1890
Mailing address:
  • Phone: 602-788-7211
  • Fax: 602-788-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number20A6865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: