Provider Demographics
NPI:1386821676
Name:NAZIRI, SUSAN (MS, L AC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:NAZIRI
Suffix:
Gender:F
Credentials:MS, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32086 CAMINO CAPISTRANO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3722
Mailing Address - Country:US
Mailing Address - Phone:949-542-9273
Mailing Address - Fax:
Practice Address - Street 1:32086 CAMINO CAPISTRANO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3722
Practice Address - Country:US
Practice Address - Phone:949-542-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202124Q00000X
CA16488171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No124Q00000XDental ProvidersDental Hygienist