Provider Demographics
NPI:1962436410
Name:PIRNAZAR, JONATHAN RAMIN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RAMIN
Last Name:PIRNAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24022 CALLE DE LA PLATA STE 300
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3629
Mailing Address - Country:US
Mailing Address - Phone:949-951-1457
Mailing Address - Fax:949-234-8295
Practice Address - Street 1:24022 CALLE DE LA PLATA
Practice Address - Street 2:SUITE 300
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3626
Practice Address - Country:US
Practice Address - Phone:949-951-1457
Practice Address - Fax:949-234-8295
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72632207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180040241OtherRAILROAD PROVIDER #
CA00A726320OtherMEDI-CAL PROVIDER #
CAG90100Medicare UPIN
CAWA72632AMedicare ID - Type Unspecified