Healthcare Provider Details

I. General information

NPI: 1699426528
Provider Name (Legal Business Name): VIDA HEJAZI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3052 S HOLLY PL
DENVER CO
80222-7011
US

IV. Provider business mailing address

3052 S HOLLY PL
DENVER CO
80222-7011
US

V. Phone/Fax

Practice location:
  • Phone: 720-556-5163
  • Fax:
Mailing address:
  • Phone: 720-556-5163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: