Provider Demographics
NPI:1104380229
Name:PAYDAR, MEHRNAZ
Entity Type:Individual
Prefix:
First Name:MEHRNAZ
Middle Name:
Last Name:PAYDAR
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 1:10414 FLOWERFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-6394
Mailing Address - Country:US
Mailing Address - Phone:240-778-9489
Mailing Address - Fax:
Practice Address - Street 1:25411 CABOT RD STE 105
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5517
Practice Address - Country:US
Practice Address - Phone:949-403-5555
Practice Address - Fax:949-403-1165
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4567133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered