Healthcare Provider Details

I. General information

NPI: 1639293640
Provider Name (Legal Business Name): SHIRAZ, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6907 LANKERSHIM BLVD
NORTH HOLLYWOOD CA
91605-6111
US

IV. Provider business mailing address

6907 LANKERSHIM BLVD
NORTH HOLLYWOOD CA
91605-6111
US

V. Phone/Fax

Practice location:
  • Phone: 818-764-3336
  • Fax: 818-764-6336
Mailing address:
  • Phone: 818-764-3336
  • Fax: 818-764-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. OLEG PILLER
Title or Position: CFO
Credential:
Phone: 818-764-3336