Provider Demographics
NPI:1538119540
Name:TIRANDAZ, MEHRAN (MD)
Entity Type:Individual
Prefix:
First Name:MEHRAN
Middle Name:
Last Name:TIRANDAZ
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:PO BOX 3148
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92690-1148
Mailing Address - Country:US
Mailing Address - Phone:949-348-1105
Mailing Address - Fax:949-348-1210
Practice Address - Street 1:17100 EUCLID STREET
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-966-7200
Practice Address - Fax:714-966-8039
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG853992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G853990OtherBLUE SHIELD OF CA
CA00G853990Medicaid
CA00G853990OtherBLUE SHIELD OF CA
CAWG85399EMedicare PIN
CA300134338Medicare PIN