Provider Demographics
NPI:1851773527
Name:MORADI, REZA
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:MORADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AHMADREZA
Other - Middle Name:
Other - Last Name:MORADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:355 PLACENTIA AVE STE 99
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3301
Mailing Address - Country:US
Mailing Address - Phone:949-444-2414
Mailing Address - Fax:
Practice Address - Street 1:355 PLACENTIA AVE STE 355
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3311
Practice Address - Country:US
Practice Address - Phone:949-444-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157047207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist