Provider Demographics
NPI:1346599859
Name:MONJEZI, MARYAM (ACUPUCTURIST)
Entity Type:Individual
Prefix:MRS
First Name:MARYAM
Middle Name:
Last Name:MONJEZI
Suffix:
Gender:F
Credentials:ACUPUCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22122 ERWIN ST
Mailing Address - Street 2:APT F 202
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3445
Mailing Address - Country:US
Mailing Address - Phone:818-261-9861
Mailing Address - Fax:
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:STE 350
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6308
Practice Address - Country:US
Practice Address - Phone:818-261-9861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13979171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist