Provider Demographics
NPI:1659338952
Name:BAREZ, SHIRIN (MD)
Entity Type:Individual
Prefix:
First Name:SHIRIN
Middle Name:
Last Name:BAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22634 2ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541
Mailing Address - Country:US
Mailing Address - Phone:510-866-5497
Mailing Address - Fax:510-886-4465
Practice Address - Street 1:1237 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541
Practice Address - Country:US
Practice Address - Phone:510-886-3937
Practice Address - Fax:510-886-6304
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75048207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E38507Medicare UPIN
CA180031838Medicare PIN