Provider Demographics
NPI:1093991002
Name:MOBARAK, HAIDEH (MD)
Entity Type:Individual
Prefix:
First Name:HAIDEH
Middle Name:
Last Name:MOBARAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CAPOBELLA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8103
Mailing Address - Country:US
Mailing Address - Phone:949-474-7445
Mailing Address - Fax:
Practice Address - Street 1:2650 S BRISTOL ST
Practice Address - Street 2:101&103
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5751
Practice Address - Country:US
Practice Address - Phone:714-754-1444
Practice Address - Fax:714-754-7009
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97509174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist