Provider Demographics
NPI:1114063898
Name:VOSSOUGHI, NEDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:NEDA
Middle Name:
Last Name:VOSSOUGHI
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 1:18582 BEACH BLVD
Mailing Address - Street 2:SUITE 23A
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648
Mailing Address - Country:US
Mailing Address - Phone:714-964-4448
Mailing Address - Fax:714-963-3780
Practice Address - Street 1:17232 RED HILL AVENUE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614
Practice Address - Country:US
Practice Address - Phone:949-752-1111
Practice Address - Fax:949-752-1133
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3530487208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
W8237Medicare ID - Type Unspecified