Provider Demographics
NPI:1225092190
Name:MAHDAD, MEHRDAD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:MICHAEL
Last Name:MAHDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:M
Other - Last Name:MAHDAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11180 WARNER AVE
Mailing Address - Street 2:#261
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7501
Mailing Address - Country:US
Mailing Address - Phone:714-546-5505
Mailing Address - Fax:714-546-0425
Practice Address - Street 1:11180 WARNER AVE
Practice Address - Street 2:#261
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7501
Practice Address - Country:US
Practice Address - Phone:714-546-5505
Practice Address - Fax:714-546-0425
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA429412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology