Provider Demographics
NPI:1265145825
Name:MIRZAEE, ANNASHARENA
Entity type:Individual
Prefix:
First Name:ANNASHARENA
Middle Name:
Last Name:MIRZAEE
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 1:2020 W HAYWARD AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-6947
Mailing Address - Country:US
Mailing Address - Phone:323-205-8425
Mailing Address - Fax:
Practice Address - Street 1:2020 W HAYWARD AVE APT 9
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-6947
Practice Address - Country:US
Practice Address - Phone:323-205-8425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker