Healthcare Provider Details

I. General information

NPI: 1912013285
Provider Name (Legal Business Name): MARCIA J VAZIRI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S TAMARAC DR
DENVER CO
80231-4394
US

IV. Provider business mailing address

3201 S TAMARAC DR
DENVER CO
80231-4394
US

V. Phone/Fax

Practice location:
  • Phone: 303-597-7777
  • Fax: 303-597-7700
Mailing address:
  • Phone: 303-597-7777
  • Fax: 303-597-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8667
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: