Provider Demographics
NPI:1780818625
Name:IZADI, MICHAEL MAZIYAR (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MAZIYAR
Last Name:IZADI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28241 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE F #182
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4441
Mailing Address - Country:US
Mailing Address - Phone:949-374-3365
Mailing Address - Fax:
Practice Address - Street 1:2081 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 109
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1119
Practice Address - Country:US
Practice Address - Phone:949-374-3365
Practice Address - Fax:949-716-7313
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28092103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical