Provider Demographics
NPI:1972678951
Name:NIKZAD, ROYA (PHD, LAC)
Entity Type:Individual
Prefix:DR
First Name:ROYA
Middle Name:
Last Name:NIKZAD
Suffix:
Gender:F
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 VILLA LA JOLLA DR.
Mailing Address - Street 2:SUITE C-117
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1707
Mailing Address - Country:US
Mailing Address - Phone:858-202-0322
Mailing Address - Fax:858-546-1575
Practice Address - Street 1:8950 VILLA LA JOLLA DR.
Practice Address - Street 2:SUITE C-117
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1707
Practice Address - Country:US
Practice Address - Phone:858-202-0322
Practice Address - Fax:858-546-1575
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4456171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist