Provider Demographics
NPI:1083837181
Name:MARZVAAN, SOHEYLA (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:SOHEYLA
Middle Name:
Last Name:MARZVAAN
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CORPORATE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2106
Mailing Address - Country:US
Mailing Address - Phone:949-481-9400
Mailing Address - Fax:949-481-9800
Practice Address - Street 1:266 S GLENDORA AVE STE A
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-653-9276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491731223E0200X
CA514111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223E0200XDental ProvidersDentistEndodontics