Provider Demographics
NPI:1457563132
Name:AZITA MESBAH MD INC
Entity Type:Organization
Organization Name:AZITA MESBAH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AZITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESBAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-910-0055
Mailing Address - Street 1:16305 SAND CANYON AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3782
Mailing Address - Country:US
Mailing Address - Phone:949-244-4731
Mailing Address - Fax:949-207-7271
Practice Address - Street 1:16305 SAND CANYON AVE
Practice Address - Street 2:STE 220
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3711
Practice Address - Country:US
Practice Address - Phone:949-244-4731
Practice Address - Fax:949-207-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76773174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG61176Medicare UPIN