Provider Demographics
NPI:1437513660
Name:LALEZARI, SHADI (MD)
Entity Type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:LALEZARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S MANCHESTER AVE
Mailing Address - Street 2:SUITE 650
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3217
Mailing Address - Country:US
Mailing Address - Phone:714-456-5253
Mailing Address - Fax:
Practice Address - Street 1:200 S MANCHESTER AVE
Practice Address - Street 2:SUITE 650
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3217
Practice Address - Country:US
Practice Address - Phone:714-456-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program