Provider Demographics
NPI:1043545635
Name:YAZDAN, SHERVIN
Entity Type:Individual
Prefix:DR
First Name:SHERVIN
Middle Name:
Last Name:YAZDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26610 YNEZ RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4697
Mailing Address - Country:US
Mailing Address - Phone:951-719-1420
Mailing Address - Fax:
Practice Address - Street 1:26610 YNEZ RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4697
Practice Address - Country:US
Practice Address - Phone:951-719-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10452T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist