Provider Demographics
NPI:1558846956
Name:AVIVA ALYESHMERNI, MD, INC.
Entity Type:Organization
Organization Name:AVIVA ALYESHMERNI, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AVIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALYESHMERNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-324-0462
Mailing Address - Street 1:26661 GRANVIA DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:369 SAN MIGUEL DR STE 235
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7816
Practice Address - Country:US
Practice Address - Phone:949-324-0462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty