Provider Demographics
NPI:1598055857
Name:SHIRZAD, ALIA (CRNA)
Entity Type:Individual
Prefix:
First Name:ALIA
Middle Name:
Last Name:SHIRZAD
Suffix:
Gender:F
Credentials:CRNA
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:450 N ROXBURY DR
Mailing Address - Street 2:STE 600
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4225
Mailing Address - Country:US
Mailing Address - Phone:310-699-8099
Mailing Address - Fax:888-906-3136
Practice Address - Street 1:14414 ADDISON ST UNIT 25
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1787
Practice Address - Country:US
Practice Address - Phone:310-699-8099
Practice Address - Fax:888-906-3136
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2017-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA636750367500000X
NJ26NR14020400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered