Provider Demographics
NPI:1942709738
Name:AZADEH SHIRAZI MD INC
Entity Type:Organization
Organization Name:AZADEH SHIRAZI MD INC
Other - Org Name:LA JOLLA DERMATOLOGY & LASER SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AZADEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-309-9831
Mailing Address - Street 1:7301 GIRARD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5151
Mailing Address - Country:US
Mailing Address - Phone:858-456-3992
Mailing Address - Fax:858-456-4010
Practice Address - Street 1:7301 GIRARD AVE STE 202
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5151
Practice Address - Country:US
Practice Address - Phone:858-456-3992
Practice Address - Fax:858-456-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty