Provider Demographics
NPI:1932304482
Name:MEISAMI, TANNAZ (MD)
Entity Type:Individual
Prefix:
First Name:TANNAZ
Middle Name:
Last Name:MEISAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16027
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-6027
Mailing Address - Country:US
Mailing Address - Phone:949-644-1025
Mailing Address - Fax:949-644-7852
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:360
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-644-1025
Practice Address - Fax:949-644-7852
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93128OtherLICENSE #
CAA93128OtherLICENSE #