Provider Demographics
NPI:1255822284
Name:TABIBZADEH, MAJIDREZA
Entity type:Individual
Prefix:
First Name:MAJIDREZA
Middle Name:
Last Name:TABIBZADEH
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 1:1300 E WILSHIRE AVE APT 230
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3946
Mailing Address - Country:US
Mailing Address - Phone:562-440-0558
Mailing Address - Fax:
Practice Address - Street 1:1300 E WILSHIRE AVE APT 230
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3946
Practice Address - Country:US
Practice Address - Phone:562-440-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18036171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist