Provider Demographics
NPI:1205913811
Name:MAZNAVI, HANIFFA M (MD)
Entity type:Individual
Prefix:
First Name:HANIFFA
Middle Name:M
Last Name:MAZNAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MUHAMMAD
Other - Middle Name:H
Other - Last Name:MAZNAVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3791 KATELLA AVE
Mailing Address - Street 2:101
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3105
Mailing Address - Country:US
Mailing Address - Phone:562-596-4403
Mailing Address - Fax:562-596-7884
Practice Address - Street 1:3791 KATELLA AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2000
Practice Address - Country:US
Practice Address - Phone:562-596-4403
Practice Address - Fax:562-596-7884
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33480174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A334800Medicaid
CAA84482Medicare UPIN
CA00A334800Medicaid