Provider Demographics
NPI:1760140354
Name:ZOROUFI, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:ZOROUFI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24050 ALISO CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3950
Mailing Address - Country:US
Mailing Address - Phone:949-298-0275
Mailing Address - Fax:
Practice Address - Street 1:24050 ALISO CREEK RD STE 1C
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3937
Practice Address - Country:US
Practice Address - Phone:949-317-4454
Practice Address - Fax:949-688-2134
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51420225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant