Provider Demographics
NPI:1053527556
Name:POURAZIMA, SHIVA (ND)
Entity type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:
Last Name:POURAZIMA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4969 PONDEROSA TER
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-5716
Mailing Address - Country:US
Mailing Address - Phone:408-836-9568
Mailing Address - Fax:
Practice Address - Street 1:145 DILLON AVE STE B
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-3020
Practice Address - Country:US
Practice Address - Phone:408-836-9568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-179172P00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered172P00000XOther Service ProvidersNaprapath
Not Answered175F00000XOther Service ProvidersNaturopath