Provider Demographics
NPI:1235359522
Name:DANAEI-BOROUMAND, SHAHRAM
Entity Type:Individual
Prefix:MR
First Name:SHAHRAM
Middle Name:
Last Name:DANAEI-BOROUMAND
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 1:146 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2462
Mailing Address - Country:US
Mailing Address - Phone:650-638-1988
Mailing Address - Fax:650-638-0788
Practice Address - Street 1:146 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2462
Practice Address - Country:US
Practice Address - Phone:650-638-1988
Practice Address - Fax:650-638-0788
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT6533225200000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist