Provider Demographics
NPI:1518443902
Name:JAFARI, SAEIDEH (HIS)
Entity Type:Individual
Prefix:
First Name:SAEIDEH
Middle Name:
Last Name:JAFARI
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18672 FLORIDA ST STE 301B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1925
Mailing Address - Country:US
Mailing Address - Phone:714-375-7776
Mailing Address - Fax:714-375-5544
Practice Address - Street 1:18672 FLORIDA ST STE 202A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-7601
Practice Address - Country:US
Practice Address - Phone:714-375-7776
Practice Address - Fax:714-375-5544
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHT9791237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHT9791OtherHEARING AID DISPENSER
CAHT9791OtherHEARING AID TRAINEE