Provider Demographics
NPI:1811360290
Name:KAZEROONI, NAZANIN
Entity type:Individual
Prefix:
First Name:NAZANIN
Middle Name:
Last Name:KAZEROONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26571 NORMANDALE DR APT 29B
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-7968
Mailing Address - Country:US
Mailing Address - Phone:949-836-6600
Mailing Address - Fax:
Practice Address - Street 1:26571 NORMANDALE DR APT 29B
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-7968
Practice Address - Country:US
Practice Address - Phone:949-836-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist