Provider Demographics
NPI:1609017813
Name:NOORIVAZIRI, MARYAM (DC)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:NOORIVAZIRI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:1511 TREAT BLVD
Practice Address - Street 2:100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-1094
Practice Address - Country:US
Practice Address - Phone:925-949-8911
Practice Address - Fax:925-949-8322
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC31165OtherCHIROPRACTIC LICENSE
CADC31165OtherCHIROPRACTIC LICENSE