Provider Demographics
NPI:1326491911
Name:BANAIAN, AZAM (NMD)
Entity Type:Individual
Prefix:MRS
First Name:AZAM
Middle Name:
Last Name:BANAIAN
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7747 W DEER VALLEY ROAD #235
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:623-487-0002
Mailing Address - Fax:623-487-0042
Practice Address - Street 1:7747 W DEER VALLEY ROAD #235
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:623-487-0002
Practice Address - Fax:623-487-0042
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-1555175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath