Provider Demographics
NPI:1700048659
Name:MIRZAIAN, SHIRLEY CHRISTINE (MS RD)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:CHRISTINE
Last Name:MIRZAIAN
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 VERDUGO BLVD # 406
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1628
Mailing Address - Country:US
Mailing Address - Phone:818-522-9851
Mailing Address - Fax:
Practice Address - Street 1:2155 VERDUGO BLVD # 406
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1628
Practice Address - Country:US
Practice Address - Phone:818-522-9851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA974811133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered