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NPI Code Detail

MEDICARE: MASOUD RAMIN MIRZAZADEH JAVAHERI

MEDICARE: MASOUD RAMIN MIRZAZADEH JAVAHERI
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
1111N00000XChiropractor6313OR

General Provider Information

NPI Number : 1649054289
Entity Type Code : Individual
Provider Name (Legal Business Name) : MASOUD RAMIN MIRZAZADEH JAVAHERI
Provider Business Mailing Address
First Line : 73 NANSEN SMT
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-1066
Country : US
Telephone Number : 503-217-9767
Fax Number :
Provider Business Practice Location Address
First Line : 8029 SE WOODSTOCK BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97206-5885
Country : US
Telephone Number : 503-774-1776
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2023
Last Update Date : 08/23/2023

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Directions to “ MASOUD RAMIN MIRZAZADEH JAVAHERI ” Practice Location

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