Provider Demographics
NPI:1053502617
Name:SERAJ, PARIZAD (DDS)
Entity Type:Individual
Prefix:
First Name:PARIZAD
Middle Name:
Last Name:SERAJ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 H ST
Mailing Address - Street 2:#4
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4321
Mailing Address - Country:US
Mailing Address - Phone:619-422-3368
Mailing Address - Fax:619-422-3301
Practice Address - Street 1:401 H ST
Practice Address - Street 2:#4
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4321
Practice Address - Country:US
Practice Address - Phone:619-422-3368
Practice Address - Fax:619-422-3301
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist