Provider Demographics
NPI:1790924769
Name:AMIRMOKRI, BEHZAD
Entity Type:Individual
Prefix:
First Name:BEHZAD
Middle Name:
Last Name:AMIRMOKRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22607 LA PALMA AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-6714
Mailing Address - Country:US
Mailing Address - Phone:714-248-3333
Mailing Address - Fax:
Practice Address - Street 1:22607 LA PALMA AVE STE 402
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-6714
Practice Address - Country:US
Practice Address - Phone:714-248-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver