Healthcare Provider Details

I. General information

NPI: 1447075577
Provider Name (Legal Business Name): SAM SHIRAZI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N LA CIENEGA BLVD STE 203
WEST HOLLYWOOD CA
90069-2493
US

IV. Provider business mailing address

1106 N LA CIENEGA BLVD STE 203
WEST HOLLYWOOD CA
90069-2493
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-8500
  • Fax: 310-652-6562
Mailing address:
  • Phone: 310-659-8500
  • Fax: 310-652-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMAN SHIRAZI-NEJAD
Title or Position: OWNER
Credential: DC
Phone: 310-659-8500