Provider Demographics
NPI:1639814593
Name:FAZELY, SAYED KEIVAAN
Entity Type:Individual
Prefix:
First Name:SAYED
Middle Name:KEIVAAN
Last Name:FAZELY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 PEREGRINE CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-8220
Mailing Address - Country:US
Mailing Address - Phone:949-419-7333
Mailing Address - Fax:
Practice Address - Street 1:3820 PEREGRINE CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-8220
Practice Address - Country:US
Practice Address - Phone:949-419-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program