Provider Demographics
NPI:1336224278
Name:DAROODI, REZA (DC)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:DAROODI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5424
Mailing Address - Country:US
Mailing Address - Phone:408-979-9559
Mailing Address - Fax:408-979-1171
Practice Address - Street 1:1746 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5424
Practice Address - Country:US
Practice Address - Phone:408-979-9559
Practice Address - Fax:408-979-1171
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22985111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU59134Medicare UPIN