Provider Demographics
NPI:1790749257
Name:MEHVAR, SHOHRE (OMD)
Entity Type:Individual
Prefix:DR
First Name:SHOHRE
Middle Name:
Last Name:MEHVAR
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:DR
Other - First Name:SHOHRE
Other - Middle Name:
Other - Last Name:MEHVAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC OMD
Mailing Address - Street 1:180 NEWPORT CENTER DR STE 145
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6983
Mailing Address - Country:US
Mailing Address - Phone:949-760-2701
Mailing Address - Fax:949-760-2722
Practice Address - Street 1:180 NEWPORT CENTER DR STE 145
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6983
Practice Address - Country:US
Practice Address - Phone:949-760-2701
Practice Address - Fax:949-760-2722
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 8313171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist