Provider Demographics
NPI:1346273810
Name:MOUSSAVI, RAMYAR (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAMYAR
Middle Name:
Last Name:MOUSSAVI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 IRVINE BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-544-1600
Mailing Address - Fax:714-544-8855
Practice Address - Street 1:1442 IRVINE BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-544-1600
Practice Address - Fax:714-544-8855
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4361213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU89471Medicare UPIN
CA00E4361Medicare ID - Type Unspecified