Provider Demographics
NPI:1891487781
Name:SHIRAZIMOHAMMADI, RAMTIN
Entity Type:Individual
Prefix:
First Name:RAMTIN
Middle Name:
Last Name:SHIRAZIMOHAMMADI
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 1:25496 MOSSWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-7402
Mailing Address - Country:US
Mailing Address - Phone:310-948-9147
Mailing Address - Fax:
Practice Address - Street 1:25496 MOSSWOOD WAY
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-7402
Practice Address - Country:US
Practice Address - Phone:310-948-9147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program