Provider Demographics
NPI:1174045736
Name:REZAEI, MOJGAN
Entity Type:Individual
Prefix:
First Name:MOJGAN
Middle Name:
Last Name:REZAEI
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 1:10371 N ORACLE RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9393
Mailing Address - Country:US
Mailing Address - Phone:520-505-1404
Mailing Address - Fax:
Practice Address - Street 1:10371 N. ORACLE RD
Practice Address - Street 2:SUITE 101A
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737
Practice Address - Country:US
Practice Address - Phone:520-505-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0981171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty