Healthcare Provider Details

I. General information

NPI: 1144480864
Provider Name (Legal Business Name): AZIZEH E. REZAIYAN MA, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 HINCKLEY RD #110
BURLINGAME CA
94010-1516
US

IV. Provider business mailing address

840 HINCKLEY RD #110
BURLINGAME CA
94010-1516
US

V. Phone/Fax

Practice location:
  • Phone: 650-692-9664
  • Fax: 650-738-3033
Mailing address:
  • Phone: 650-692-9664
  • Fax: 650-738-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC# 39248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: