Provider Demographics
NPI:1073936993
Name:ALIREZAIEYAN, DARIUSH
Entity Type:Individual
Prefix:
First Name:DARIUSH
Middle Name:
Last Name:ALIREZAIEYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 JOHNS CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-3632
Mailing Address - Country:US
Mailing Address - Phone:817-561-4542
Mailing Address - Fax:817-483-4068
Practice Address - Street 1:6601 JOHNS CRT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016
Practice Address - Country:US
Practice Address - Phone:817-561-4542
Practice Address - Fax:817-483-4068
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17524777897246ZE0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG