Provider Demographics
NPI:1831212885
Name:BADIE, MEHRNAZ (MD)
Entity type:Individual
Prefix:DR
First Name:MEHRNAZ
Middle Name:
Last Name:BADIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SEYEDEH
Other - Middle Name:MEHRNAZ
Other - Last Name:BADIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:26522 LA ALAMEDA
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6330
Mailing Address - Country:US
Mailing Address - Phone:949-282-1671
Mailing Address - Fax:949-367-0518
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 325
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6384
Practice Address - Country:US
Practice Address - Phone:949-364-6000
Practice Address - Fax:949-364-9561
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98114207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A981140Medicaid
CA00A981140Medicaid
CAGV947ZMedicare PIN