Provider Demographics
NPI:1417359381
Name:ZABANAVAR, PAYAM
Entity Type:Individual
Prefix:
First Name:PAYAM
Middle Name:
Last Name:ZABANAVAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 VENETO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5955
Mailing Address - Country:US
Mailing Address - Phone:949-228-2233
Mailing Address - Fax:
Practice Address - Street 1:2124 MAIN ST STE 165
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6429
Practice Address - Country:US
Practice Address - Phone:949-228-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program