Provider Demographics
NPI:1750449062
Name:LAVI, DARIUSH S (MD)
Entity Type:Individual
Prefix:DR
First Name:DARIUSH
Middle Name:S
Last Name:LAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DARIUSH
Other - Middle Name:S
Other - Last Name:LAVI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1503 S COAST DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1534
Mailing Address - Country:US
Mailing Address - Phone:714-585-1842
Mailing Address - Fax:714-434-3684
Practice Address - Street 1:1503 S COAST DR STE 109
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1526
Practice Address - Country:US
Practice Address - Phone:714-585-1842
Practice Address - Fax:714-963-0350
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine