Provider Demographics
NPI:1902069404
Name:VAZIRNEZAMI, MASOUD
Entity Type:Individual
Prefix:
First Name:MASOUD
Middle Name:
Last Name:VAZIRNEZAMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 LA JOLLA VILLAGE DR
Mailing Address - Street 2:STE 107
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-8402
Mailing Address - Country:US
Mailing Address - Phone:619-734-8877
Mailing Address - Fax:978-313-6824
Practice Address - Street 1:4130 LA JOLLA VILLAGE DR
Practice Address - Street 2:STE 208
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9121
Practice Address - Country:US
Practice Address - Phone:858-678-0081
Practice Address - Fax:858-678-8580
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2716237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter