Provider Demographics
NPI:1134234131
Name:ZABETIAN, MOHSEN (MD)
Entity type:Individual
Prefix:
First Name:MOHSEN
Middle Name:
Last Name:ZABETIAN
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 1:2390 E FLORIDA AVE
Mailing Address - Street 2:# 203
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-4707
Mailing Address - Country:US
Mailing Address - Phone:951-929-6260
Mailing Address - Fax:951-765-2855
Practice Address - Street 1:2390 E FLORIDA AVE
Practice Address - Street 2:# 203
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4707
Practice Address - Country:US
Practice Address - Phone:951-929-6260
Practice Address - Fax:951-765-2855
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23324208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A233240Medicare ID - Type Unspecified
CAA23324Medicare UPIN