Provider Demographics
NPI:1760068902
Name:MOATAZEDI, YASMIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YASMIN
Middle Name:
Last Name:MOATAZEDI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 FINCH
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1434
Mailing Address - Country:US
Mailing Address - Phone:949-838-4144
Mailing Address - Fax:
Practice Address - Street 1:8810 GROSSMONT BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9027
Practice Address - Country:US
Practice Address - Phone:619-403-5392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist