Provider Demographics
NPI:1326087727
Name:POURADIB, AMIR ABBAS (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:ABBAS
Last Name:POURADIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4034
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92616-4034
Mailing Address - Country:US
Mailing Address - Phone:949-588-7246
Mailing Address - Fax:949-272-3746
Practice Address - Street 1:24012 CALLE DE LA PLATA STE 120
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3632
Practice Address - Country:US
Practice Address - Phone:949-588-7246
Practice Address - Fax:949-272-3746
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA809292081P2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAPPLYINGMedicaid
CAH93147Medicare UPIN
CAAPPLYINGMedicare ID - Type Unspecified