Provider Demographics
NPI:1477908143
Name:AZIMI SADJADI, SANAZ M (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:SANAZ
Middle Name:M
Last Name:AZIMI SADJADI
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 VIA CRUZ
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-8521
Mailing Address - Country:US
Mailing Address - Phone:310-430-6788
Mailing Address - Fax:
Practice Address - Street 1:430 VIA CRUZ
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-8521
Practice Address - Country:US
Practice Address - Phone:310-430-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist