Provider Demographics
NPI:1275641102
Name:MOZAFFARIAN, ELAHEH (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELAHEH
Middle Name:
Last Name:MOZAFFARIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:ELAHEH
Other - Middle Name:
Other - Last Name:RAHNAMAIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5706 BALTIMORE DR
Mailing Address - Street 2:#343
Mailing Address - City:LAMESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1655
Mailing Address - Country:US
Mailing Address - Phone:619-559-1449
Mailing Address - Fax:
Practice Address - Street 1:9745 PROSPECT AVE
Practice Address - Street 2:STE 102
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4273
Practice Address - Country:US
Practice Address - Phone:619-449-8946
Practice Address - Fax:619-449-5127
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist