Provider Demographics
NPI:1659892578
Name:SHIRAZI, SARA (DPM)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:SHIRAZI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 E WALNUT ST STE 220
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-5363
Mailing Address - Country:US
Mailing Address - Phone:626-517-0022
Mailing Address - Fax:
Practice Address - Street 1:959 E WALNUT ST STE 220
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-5363
Practice Address - Country:US
Practice Address - Phone:626-517-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5611213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery