Healthcare Provider Details

I. General information

NPI: 1215587704
Provider Name (Legal Business Name): MEHRNOUSH RAISSI ARDALI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

7811 TALBERT AVE APT 19
HUNTINGTON BEACH CA
92648-1387
US

IV. Provider business mailing address

7711 TALBERT AVE APT 19
HUNTINGTON BEACH CA
92648-1320
US

V. Phone/Fax

Practice location:
  • Phone: 949-662-8969
  • Fax:
Mailing address:
  • Phone: 949-662-8969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: