Healthcare Provider Details

I. General information

NPI: 1033179676
Provider Name (Legal Business Name): NAZITA ADILI-KHAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALTON PARKWAY STE 101
IRVINE CA
92606-5032
US

IV. Provider business mailing address

2500 ALTON PARKWAY STE 101
IRVINE CA
92606-5032
US

V. Phone/Fax

Practice location:
  • Phone: 949-222-2722
  • Fax: 949-222-9969
Mailing address:
  • Phone: 949-222-2722
  • Fax: 949-222-9969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47830
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC53969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: