Provider Demographics
NPI:1396146924
Name:EMAMI, SHAHRZAD (CNC)
Entity type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:
Last Name:EMAMI
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2952
Mailing Address - Country:US
Mailing Address - Phone:818-795-7472
Mailing Address - Fax:
Practice Address - Street 1:2728 STEVENS ST
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-2952
Practice Address - Country:US
Practice Address - Phone:818-795-7472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory