Provider Demographics
NPI:1255700712
Name:FOROODI, SHAHRZAD (MS, RD, CDCES)
Entity type:Individual
Prefix:MRS
First Name:SHAHRZAD
Middle Name:
Last Name:FOROODI
Suffix:
Gender:F
Credentials:MS, RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27629 YARDLEY WAY
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1606
Mailing Address - Country:US
Mailing Address - Phone:818-987-5003
Mailing Address - Fax:
Practice Address - Street 1:1131 CAMPBELL ST APT 229
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-1687
Practice Address - Country:US
Practice Address - Phone:818-987-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
CA1038804133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered