Provider Demographics
NPI:1962815779
Name:MOZHGAN ASHTARI MD PC
Entity Type:Organization
Organization Name:MOZHGAN ASHTARI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ MD
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOZHGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHTARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:551-206-5779
Mailing Address - Street 1:23141 MOULTON PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1241
Mailing Address - Country:US
Mailing Address - Phone:949-305-2711
Mailing Address - Fax:949-502-8887
Practice Address - Street 1:23141 MOULTON PKWY STE 202
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1241
Practice Address - Country:US
Practice Address - Phone:949-305-2711
Practice Address - Fax:949-502-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111582207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty