Provider Demographics
NPI:1184670630
Name:MESBAH, AZITA (MD)
Entity Type:Individual
Prefix:
First Name:AZITA
Middle Name:
Last Name:MESBAH
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 1:16305 SAND CANYON AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3782
Mailing Address - Country:US
Mailing Address - Phone:949-244-4731
Mailing Address - Fax:949-207-7272
Practice Address - Street 1:16305 SAND CANYON AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3711
Practice Address - Country:US
Practice Address - Phone:949-244-4731
Practice Address - Fax:949-207-7272
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76773207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G61176Medicare UPIN
CAWA76773AMedicare ID - Type Unspecified