Healthcare Provider Details

I. General information

NPI: 1598055857
Provider Name (Legal Business Name): ALIA SHIRZAD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14414 ADDISON ST UNIT 25
SHERMAN OAKS CA
91423-1787
US

IV. Provider business mailing address

450 N ROXBURY DR STE 600
BEVERLY HILLS CA
90210-4225
US

V. Phone/Fax

Practice location:
  • Phone: 310-699-8099
  • Fax: 888-906-3136
Mailing address:
  • Phone: 310-699-8099
  • Fax: 888-906-3136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number636750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: