Provider Demographics
NPI:1720860075
Name:TAGHIZADEH, SANAZ (PA)
Entity Type:Individual
Prefix:
First Name:SANAZ
Middle Name:
Last Name:TAGHIZADEH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28521 RANCHO GRANDE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7436
Mailing Address - Country:US
Mailing Address - Phone:949-485-0544
Mailing Address - Fax:
Practice Address - Street 1:6825 QUAIL HILL PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-4234
Practice Address - Country:US
Practice Address - Phone:949-854-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63079363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty