Healthcare Provider Details

I. General information

NPI: 1467719997
Provider Name (Legal Business Name): MISS SHAHRZAD MORIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2012
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 N PALM DR APT 202
BEVERLY HILLS CA
90210-4026
US

IV. Provider business mailing address

406 N PALM DR APT 202
BEVERLY HILLS CA
90210-4026
US

V. Phone/Fax

Practice location:
  • Phone: 310-413-0155
  • Fax:
Mailing address:
  • Phone: 310-413-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number100127
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: