Provider Demographics
NPI:1245915461
Name:ROSHANZAER, DEEYANA
Entity type:Individual
Prefix:
First Name:DEEYANA
Middle Name:
Last Name:ROSHANZAER
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 1:52 GULL WAY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1327
Mailing Address - Country:US
Mailing Address - Phone:714-380-2856
Mailing Address - Fax:
Practice Address - Street 1:52 GULL WAY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1327
Practice Address - Country:US
Practice Address - Phone:714-380-2856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst