1659438984 NPI number — SHERIN K SHIRAZI M.D.

Table of content: SHERIN K SHIRAZI M.D. (NPI 1659438984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659438984 NPI number — SHERIN K SHIRAZI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIRAZI
Provider First Name:
SHERIN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659438984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 E GLENARM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91105-3418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-768-4415
Provider Business Mailing Address Fax Number:
626-403-0321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 S ARROYO PKWY STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105-3930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-795-9023
Provider Business Practice Location Address Fax Number:
626-797-1731
Provider Enumeration Date:
01/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086X0206X , with the licence number:  A62828 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A628280 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A62828 . This is a "LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".