Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 22985 | CA |
NPI | 1336224278 |
---|---|
Provider Name | Dr. Reza Daroodi |
First Address | San Jose, CA 95125-5424 |
Second Address | San Jose, CA 95125-5424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 27/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U59134 | (02) | CA |