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General NPI Number Information
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NPI Number | 1417247859
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Entity Type | Organization
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Legal Business Name | BRANDON VAZIRIAN MFT
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 14351 RED HILL AVE SUITE C
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City | TUSTIN
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State | CA
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Zip | 92780-6271
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Country | US
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Telephone | 714-980-3912
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Fax | 714-838-5560
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Provider Business Mailing Address
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Address Line | 14351 RED HILL AVE SUITE C
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City | TUSTIN
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State | CA
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Zip | 92780-6271
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Country | US
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Telephone | 714-980-3912
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Fax | 714-838-5560
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRANDON ALI VAZIRIAN
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Credential | MFT
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Telephone | 714-980-3912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | MFC47913
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number |
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License Number State |
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