Provider Demographics
NPI:1942074562
Name:DAVOODI, IRIS
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:DAVOODI
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 1:3530 HOLDING ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-2232
Mailing Address - Country:US
Mailing Address - Phone:909-636-2571
Mailing Address - Fax:
Practice Address - Street 1:3530 HOLDING ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-2232
Practice Address - Country:US
Practice Address - Phone:909-636-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide