Provider Demographics
NPI:1093102931
Name:REZA DAROODI INC
Entity Type:Organization
Organization Name:REZA DAROODI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAROODI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-979-9559
Mailing Address - Street 1:1746 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5424
Mailing Address - Country:US
Mailing Address - Phone:408-979-9559
Mailing Address - Fax:408-979-1171
Practice Address - Street 1:1746 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5424
Practice Address - Country:US
Practice Address - Phone:408-979-9559
Practice Address - Fax:408-979-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty