Provider Demographics
NPI:1518472802
Name:MASHAYEKHI, MAHBOUBEH
Entity Type:Individual
Prefix:
First Name:MAHBOUBEH
Middle Name:
Last Name:MASHAYEKHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 TALISMAN APT 235
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3847
Mailing Address - Country:US
Mailing Address - Phone:949-705-7177
Mailing Address - Fax:
Practice Address - Street 1:7772 WARNER AVE STE 102
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-8028
Practice Address - Country:US
Practice Address - Phone:714-587-9325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist