Provider Demographics
NPI:1619521556
Name:SAFAVI, MAHSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHSA
Middle Name:
Last Name:SAFAVI
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 1:9304 VIRTUOSO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-0368
Mailing Address - Country:US
Mailing Address - Phone:416-318-0188
Mailing Address - Fax:
Practice Address - Street 1:800 CORPORATE DR STE 100
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-1153
Practice Address - Country:US
Practice Address - Phone:949-364-9112
Practice Address - Fax:949-364-9016
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC160553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine