Provider Demographics
NPI:1063580462
Name:TABRIZY, SIAVASH (MS, MFT, PHD)
Entity type:Individual
Prefix:DR
First Name:SIAVASH
Middle Name:
Last Name:TABRIZY
Suffix:
Gender:M
Credentials:MS, MFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17852 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2801
Mailing Address - Country:US
Mailing Address - Phone:562-987-2104
Mailing Address - Fax:
Practice Address - Street 1:3408 E BROADWAY
Practice Address - Street 2:STE. A
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5907
Practice Address - Country:US
Practice Address - Phone:562-987-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33830170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS