Provider Demographics
NPI:1518056027
Name:ZAMANI, MAZIAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MAZIAR
Middle Name:
Last Name:ZAMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24221 CALLE DE LA LOUISA
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7638
Mailing Address - Country:US
Mailing Address - Phone:949-770-2085
Mailing Address - Fax:949-916-1604
Practice Address - Street 1:24221 CALLE DE LA LOUISA
Practice Address - Street 2:SUITE 400
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7638
Practice Address - Country:US
Practice Address - Phone:949-770-2085
Practice Address - Fax:949-916-1604
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG84706Medicare UPIN