Provider Demographics
NPI:1508999301
Name:NOURIZADEH, MAHZADEH (NP)
Entity Type:Individual
Prefix:
First Name:MAHZADEH
Middle Name:
Last Name:NOURIZADEH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MAHZADEH
Other - Middle Name:
Other - Last Name:NOURIZADEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:10792 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-6412
Mailing Address - Country:US
Mailing Address - Phone:714-335-8802
Mailing Address - Fax:
Practice Address - Street 1:700 S TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3425
Practice Address - Country:US
Practice Address - Phone:714-922-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16158363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner