Provider Demographics
NPI:1689060113
Name:MIRZAIAN, ARA (CO)
Entity Type:Individual
Prefix:MR
First Name:ARA
Middle Name:
Last Name:MIRZAIAN
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 SANTA FE DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5137
Mailing Address - Country:US
Mailing Address - Phone:760-479-1866
Mailing Address - Fax:760-334-0344
Practice Address - Street 1:351 SANTA FE DR
Practice Address - Street 2:SUITE 240
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5137
Practice Address - Country:US
Practice Address - Phone:760-479-1866
Practice Address - Fax:760-334-0344
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist