Healthcare Provider Details

I. General information

NPI: 1558611863
Provider Name (Legal Business Name): HOOTAN DANESHMAND M D INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27462 PORTOLA PKWY SUITE 100
FOOTHILL RANCH CA
92610-2838
US

IV. Provider business mailing address

27462 PORTOLA PKWY SUITE 100
FOOTHILL RANCH CA
92610-2838
US

V. Phone/Fax

Practice location:
  • Phone: 949-727-9099
  • Fax: 949-727-2030
Mailing address:
  • Phone: 949-727-9099
  • Fax: 949-727-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: HOOTAN M DANESHMAND
Title or Position: PRESIDENT
Credential: MD
Phone: 949-727-9099