Provider Demographics
NPI:1245515014
Name:REZAIE, SAMAN (ND)
Entity type:Individual
Prefix:
First Name:SAMAN
Middle Name:
Last Name:REZAIE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 E RAINTREE DR
Mailing Address - Street 2:100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7308
Mailing Address - Country:US
Mailing Address - Phone:210-632-3638
Mailing Address - Fax:480-553-8616
Practice Address - Street 1:9200 E RAINTREE DR
Practice Address - Street 2:100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7308
Practice Address - Country:US
Practice Address - Phone:210-632-3638
Practice Address - Fax:480-553-8616
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11-1282175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath