Provider Demographics
NPI:1013080621
Name:MOHSENI, RIZWANA (DO)
Entity Type:Individual
Prefix:MRS
First Name:RIZWANA
Middle Name:
Last Name:MOHSENI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23672 BIRTCHER DR
Mailing Address - Street 2:UNIT A
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1711
Mailing Address - Country:US
Mailing Address - Phone:949-770-7301
Mailing Address - Fax:949-770-0634
Practice Address - Street 1:23672 BIRTCHER DR
Practice Address - Street 2:UNIT A
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1711
Practice Address - Country:US
Practice Address - Phone:949-770-7301
Practice Address - Fax:949-770-0634
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine