Provider Demographics
NPI:1598391799
Name:SHIRALI, IMAN (PHD)
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:
Last Name:SHIRALI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 S STATE COLLEGE BLVD UNIT 430
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-8921
Mailing Address - Country:US
Mailing Address - Phone:858-997-7415
Mailing Address - Fax:
Practice Address - Street 1:1818 S STATE COLLEGE BLVD UNIT 430
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-8921
Practice Address - Country:US
Practice Address - Phone:858-997-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty