1225092190 NPI number — DR. MEHRDAD MICHAEL MAHDAD M.D.

Table of content: DR. MEHRDAD MICHAEL MAHDAD M.D. (NPI 1225092190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225092190 NPI number — DR. MEHRDAD MICHAEL MAHDAD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHDAD
Provider First Name:
MEHRDAD
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAHDAD
Provider Other First Name:
MICHAEL
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1225092190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11180 WARNER AVE
Provider Second Line Business Mailing Address:
#261
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-7501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-546-5505
Provider Business Mailing Address Fax Number:
714-546-0425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11180 WARNER AVE
Provider Second Line Business Practice Location Address:
#261
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-7501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-546-5505
Provider Business Practice Location Address Fax Number:
714-546-0425
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  A42941 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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