Provider Demographics
NPI:1699045831
Name:MEGHROUNI, VAHE (MD)
Entity Type:Individual
Prefix:
First Name:VAHE
Middle Name:
Last Name:MEGHROUNI
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 1:61 CAPE ANDOVER
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8401
Mailing Address - Country:US
Mailing Address - Phone:949-650-2326
Mailing Address - Fax:
Practice Address - Street 1:61 CAPE ANDOVER
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8401
Practice Address - Country:US
Practice Address - Phone:949-650-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE16352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAFE16352OtherMEDICAL LICENSE