Individual
REZA SHIRAZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3366 5TH AVE, SAN DIEGO, CA 92103-5713
(619) 230-0400
(858) 429-7936
Mailing address
PO BOX 33865, SAN DIEGO, CA 92163-3865
(858) 888-7700
(858) 888-7721
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A95800
CA
2085R0001X
Radiation Oncology Physician
Primary
A95800
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A958000
—
CA
01
—
11621447
CAQH ID
CA
01
—
87929
OHIO STATE LICENSE
OH
01
—
A95800
STATE LICENSE
CA
Enumeration date
06/23/2006
Last updated
10/06/2020
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