Healthcare Provider Details

I. General information

NPI: 1730148578
Provider Name (Legal Business Name): ARAM SHAHMIRIZADEH CRAIG PA-C, MMS, RKT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23560 MADISON ST STE 103
TORRANCE CA
90505-4709
US

IV. Provider business mailing address

PO BOX 15726
LONG BEACH CA
90815-0726
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-9200
  • Fax:
Mailing address:
  • Phone: 310-948-0963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: