Healthcare Provider Details

I. General information

NPI: 1760707152
Provider Name (Legal Business Name): GISOO ZARRABI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 VICTORIA ST
COSTA MESA CA
92627-1906
US

IV. Provider business mailing address

27201 S RIDGE DR
MISSION VIEJO CA
92692-5011
US

V. Phone/Fax

Practice location:
  • Phone: 949-722-7118
  • Fax:
Mailing address:
  • Phone: 949-470-1610
  • Fax: 949-470-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA117990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: