Provider Demographics
NPI:1558691451
Name:ASHTARI, MOZHGAN (MD)
Entity Type:Individual
Prefix:
First Name:MOZHGAN
Middle Name:
Last Name:ASHTARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23141 MOULTON PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1241
Mailing Address - Country:US
Mailing Address - Phone:949-600-6334
Mailing Address - Fax:949-600-6454
Practice Address - Street 1:23141 MOULTON PKWY 202
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1241
Practice Address - Country:US
Practice Address - Phone:949-600-6334
Practice Address - Fax:949-600-6454
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111582207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6140717019OtherCIGNA
CA0149051291OtherUNITED HEALTHCARE WEST MONARCH OC
CA162668OtherHEALTHNET
538598OtherAETNA