Provider Demographics
NPI:1962205674
Name:GOUDARZI, ARIAZ
Entity type:Individual
Prefix:
First Name:ARIAZ
Middle Name:
Last Name:GOUDARZI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8454 HOLLY LEAF DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2225
Mailing Address - Country:US
Mailing Address - Phone:703-678-8943
Mailing Address - Fax:
Practice Address - Street 1:8454 HOLLY LEAF DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2225
Practice Address - Country:US
Practice Address - Phone:703-678-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program