Provider Demographics
NPI:1588645964
Name:MIRHOSENI, NADER (MD)
Entity Type:Individual
Prefix:DR
First Name:NADER
Middle Name:
Last Name:MIRHOSENI
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 1:26691 PLAZA STE 150
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6347
Mailing Address - Country:US
Mailing Address - Phone:949-348-2900
Mailing Address - Fax:949-348-0960
Practice Address - Street 1:26691 PLAZA STE 150
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6329
Practice Address - Country:US
Practice Address - Phone:949-348-2900
Practice Address - Fax:949-348-0960
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85775207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI32464Medicare UPIN