Provider Demographics
NPI:1700364718
Name:HOSSEINI ZARE, MAHSHIDSADAT
Entity Type:Individual
Prefix:
First Name:MAHSHIDSADAT
Middle Name:
Last Name:HOSSEINI ZARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 PAYTON
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3456
Mailing Address - Country:US
Mailing Address - Phone:832-707-5233
Mailing Address - Fax:
Practice Address - Street 1:6644 IRVINE CENTER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2117
Practice Address - Country:US
Practice Address - Phone:832-707-5233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty