Provider Demographics
NPI:1417247859
Name:BRANDON VAZIRIAN MFT
Entity Type:Organization
Organization Name:BRANDON VAZIRIAN MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:VAZIRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:714-980-3912
Mailing Address - Street 1:14351 RED HILL AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6271
Mailing Address - Country:US
Mailing Address - Phone:714-980-3912
Mailing Address - Fax:714-838-5560
Practice Address - Street 1:14351 RED HILL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6271
Practice Address - Country:US
Practice Address - Phone:714-980-3912
Practice Address - Fax:714-838-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47913273R00000X
273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
No273R00000XHospital UnitsPsychiatric Unit