Healthcare Provider Details

I. General information

NPI: 1609554476
Provider Name (Legal Business Name): MRS. PARYA VISHEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/30/2023
Certification Date: 07/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26730 TOWNE CENTRE DR STE 102
FOOTHILL RANCH CA
92610-2857
US

IV. Provider business mailing address

26730 TOWNE CENTRE DR STE 102
FOOTHILL RANCH CA
92610-2857
US

V. Phone/Fax

Practice location:
  • Phone: 949-559-5153
  • Fax: 949-559-5252
Mailing address:
  • Phone: 949-559-5153
  • Fax: 949-559-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF07230424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: