Provider Demographics
NPI:1083437982
Name:GHAZVINI, MEHRAN COREY I (DOM)
Entity type:Individual
Prefix:DR
First Name:MEHRAN
Middle Name:COREY
Last Name:GHAZVINI
Suffix:I
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 ROYAL PALM WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3541
Mailing Address - Country:US
Mailing Address - Phone:850-545-6314
Mailing Address - Fax:
Practice Address - Street 1:2820 REMINGTON GREEN CIR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-1547
Practice Address - Country:US
Practice Address - Phone:850-545-6314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4195171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist