Provider Demographics
NPI:1336243385
Name:DARIUSHNIA, ALEX R (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:R
Last Name:DARIUSHNIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:DARIUSHNIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2617 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2617 E CHAPMAN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3226
Practice Address - Country:US
Practice Address - Phone:714-538-4576
Practice Address - Fax:714-288-0738
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA064803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH16735Medicare UPIN
CAA64803Medicare ID - Type Unspecified