Provider Demographics
NPI:1275697765
Name:LUNDQUIST, MEHRANGIZ RAJABI (PHD)
Entity Type:Individual
Prefix:
First Name:MEHRANGIZ
Middle Name:RAJABI
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7501
Mailing Address - Country:US
Mailing Address - Phone:949-640-8200
Mailing Address - Fax:949-640-8200
Practice Address - Street 1:200 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 305
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7504
Practice Address - Country:US
Practice Address - Phone:949-640-8200
Practice Address - Fax:949-640-8200
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY146182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP14618Medicare ID - Type Unspecified