Provider Demographics
NPI:1417366915
Name:MIRZADA, NEELOUFAR
Entity Type:Individual
Prefix:
First Name:NEELOUFAR
Middle Name:
Last Name:MIRZADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 BARRANCA PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1713
Mailing Address - Country:US
Mailing Address - Phone:562-448-9217
Mailing Address - Fax:
Practice Address - Street 1:4000 BARRANCA PKWY STE 250
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1713
Practice Address - Country:US
Practice Address - Phone:562-448-9217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96320106H00000X
CA78921225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist