Healthcare Provider Details

I. General information

NPI: 1346669389
Provider Name (Legal Business Name): SAMRA VAZIRIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 TORRANCE BLVD STE 560
TORRANCE CA
90503-4583
US

IV. Provider business mailing address

21143 HAWTHORNE BLVD STE 280
TORRANCE CA
90503-4615
US

V. Phone/Fax

Practice location:
  • Phone: 310-502-5628
  • Fax:
Mailing address:
  • Phone: 424-213-1984
  • Fax: 310-542-2607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberA153417
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number257817
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA153417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: