Healthcare Provider Details

I. General information

NPI: 1659463313
Provider Name (Legal Business Name): BRANDON ALI VAZIRIAN MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 E CHAPMAN AVE STE 202
ORANGE CA
92866-2130
US

IV. Provider business mailing address

7600 GRAVES AVE
ROSEMEAD CA
91770-3414
US

V. Phone/Fax

Practice location:
  • Phone: 626-280-6510
  • Fax:
Mailing address:
  • Phone: 714-875-3982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC47913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: