Provider Demographics
NPI:1124746318
Name:ARJOMANDI, SHAHRZAD (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:
Last Name:ARJOMANDI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SEMBRADO
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2709
Mailing Address - Country:US
Mailing Address - Phone:949-201-5970
Mailing Address - Fax:
Practice Address - Street 1:26024 ACERO
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2768
Practice Address - Country:US
Practice Address - Phone:714-545-5550
Practice Address - Fax:949-609-0374
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA62669363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant