Provider Demographics
NPI:1457126492
Name:IRIS DAVOODI LIVING SOBER
Entity Type:Organization
Organization Name:IRIS DAVOODI LIVING SOBER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVOODI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-636-2571
Mailing Address - Street 1:3530 HOLDING ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-2232
Mailing Address - Country:US
Mailing Address - Phone:909-636-2571
Mailing Address - Fax:
Practice Address - Street 1:3530 HOLDING ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-2232
Practice Address - Country:US
Practice Address - Phone:909-636-2571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging