Healthcare Provider Details

I. General information

NPI: 1013321348
Provider Name (Legal Business Name): BABAK ZOLFAGHARI-AZAR MS, QMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2014
Last Update Date: 06/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 RIVER RD S
SALEM OR
97302-9754
US

IV. Provider business mailing address

2905 RIVER RD S
SALEM OR
97302-9754
US

V. Phone/Fax

Practice location:
  • Phone: 503-602-0545
  • Fax: 503-391-6337
Mailing address:
  • Phone: 503-602-0545
  • Fax: 503-391-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: