Provider Demographics
NPI:1477737161
Name:SANAEI, NAZANIN (MD)
Entity Type:Individual
Prefix:
First Name:NAZANIN
Middle Name:
Last Name:SANAEI
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 1:20151 SW BIRCH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1794
Mailing Address - Country:US
Mailing Address - Phone:949-270-2100
Mailing Address - Fax:949-650-4458
Practice Address - Street 1:307 PLACENTIA AVE STE 107
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3307
Practice Address - Country:US
Practice Address - Phone:949-270-2100
Practice Address - Fax:949-650-4458
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107153208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A1071530Medicaid
CAFS1334426OtherDEA
CAFS1334426OtherDEA