Healthcare Provider Details

I. General information

NPI: 1093102931
Provider Name (Legal Business Name): REZA DAROODI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1746 HAMILTON AVE
SAN JOSE CA
95125-5424
US

IV. Provider business mailing address

1746 HAMILTON AVE
SAN JOSE CA
95125-5424
US

V. Phone/Fax

Practice location:
  • Phone: 408-979-9559
  • Fax: 408-979-1171
Mailing address:
  • Phone: 408-979-9559
  • Fax: 408-979-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC22985
License Number StateCA

VIII. Authorized Official

Name: MR. REZA DAROODI
Title or Position: PRESIDENT
Credential: DC
Phone: 408-979-9559