MEDICARE: DR. REZA DAROODI DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	22985	CA

General Provider Information

NPI Number	:	1336224278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REZA DAROODI DC

Provider Business Mailing Address
First Line	:	1746 HAMILTON AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5424
Country	:	US
Telephone Number	:	408-979-9559
Fax Number	:	408-979-1171

Provider Business Practice Location Address
First Line	:	1746 HAMILTON AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5424
Country	:	US
Telephone Number	:	408-979-9559
Fax Number	:	408-979-1171

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	01/27/2017

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