Provider Demographics
NPI:1578758017
Name:SHIRAZI, ZIBA AZIM (DMD)
Entity Type:Individual
Prefix:
First Name:ZIBA
Middle Name:AZIM
Last Name:SHIRAZI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13316 LANDFAIR ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-0001
Mailing Address - Country:US
Mailing Address - Phone:617-699-6314
Mailing Address - Fax:858-748-5815
Practice Address - Street 1:14761 POMERADO ROAD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:858-748-5815
Practice Address - Fax:858-748-6130
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist