Healthcare Provider Details

I. General information

NPI: 1427655463
Provider Name (Legal Business Name): PARIA VAZIRI ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 1/2 REED AVE
SAN DIEGO CA
92109-5361
US

IV. Provider business mailing address

1559 1/2 REED AVE
SAN DIEGO CA
92109-5361
US

V. Phone/Fax

Practice location:
  • Phone: 571-205-8696
  • Fax:
Mailing address:
  • Phone: 571-205-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: