Provider Demographics
NPI:1134484496
Name:ESTEGHLALIAN, MANIJEH
Entity Type:Individual
Prefix:
First Name:MANIJEH
Middle Name:
Last Name:ESTEGHLALIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MANIJEH
Other - Middle Name:
Other - Last Name:SMYTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5319 UNIVERSITY DR # 151
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2965
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22041 OAK GRV
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-4302
Practice Address - Country:US
Practice Address - Phone:714-550-0202
Practice Address - Fax:714-550-0201
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor