Provider Demographics
NPI:1558651729
Name:JONATHAN R PIRNAZAR M.D. A PC
Entity Type:Organization
Organization Name:JONATHAN R PIRNAZAR M.D. A PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-951-1457
Mailing Address - Street 1:24022 CALLE DE LA PLATA
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3626
Mailing Address - Country:US
Mailing Address - Phone:949-951-1457
Mailing Address - Fax:949-768-8902
Practice Address - Street 1:24022 CALLE DE LA PLATA
Practice Address - Street 2:SUITE 300
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3626
Practice Address - Country:US
Practice Address - Phone:949-951-1457
Practice Address - Fax:949-768-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72632207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG90100Medicare UPIN
CAWA72632CMedicare PIN