Provider Demographics
NPI:1922247634
Name:GHAZVINI MD,INC
Entity Type:Organization
Organization Name:GHAZVINI MD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZVINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-770-8100
Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA # 430
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-770-8100
Mailing Address - Fax:949-770-8121
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA # 430
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-770-8100
Practice Address - Fax:949-770-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA80873BMedicare PIN