Provider Demographics
NPI:1538701693
Name:SHIRAZI, RAMIN P III
Entity Type:Individual
Prefix:MR
First Name:RAMIN
Middle Name:P
Last Name:SHIRAZI
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25411 MINA CT
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-5311
Mailing Address - Country:US
Mailing Address - Phone:949-929-7281
Mailing Address - Fax:
Practice Address - Street 1:25411 MINA CT
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-5311
Practice Address - Country:US
Practice Address - Phone:949-929-7281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TCP-33502171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty