Provider Demographics
NPI:1508362401
Name:IRANNEJAD, ARIAN (PT)
Entity Type:Individual
Prefix:
First Name:ARIAN
Middle Name:
Last Name:IRANNEJAD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 ORCHARD DR APT B
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-7423
Mailing Address - Country:US
Mailing Address - Phone:858-539-9761
Mailing Address - Fax:
Practice Address - Street 1:1211 W LA PALMA AVE STE 602
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2813
Practice Address - Country:US
Practice Address - Phone:657-251-9210
Practice Address - Fax:657-202-2711
Is Sole Proprietor?:No
Enumeration Date:2018-04-01
Last Update Date:2018-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist