Provider Demographics
NPI:1558755454
Name:TAMRAZZADEH, CYNTHIA NAIR
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:NAIR
Last Name:TAMRAZZADEH
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 1:3340 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2548
Mailing Address - Country:US
Mailing Address - Phone:786-657-6555
Mailing Address - Fax:
Practice Address - Street 1:1016 E BROADWAY
Practice Address - Street 2:SUITE #101
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4532
Practice Address - Country:US
Practice Address - Phone:818-396-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52659225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist