Healthcare Provider Details

I. General information

NPI: 1053310946
Provider Name (Legal Business Name): FIROOZEH JAHROUMI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15785 LAGUNA CANYON RD SUITE 310
IRVINE CA
92618-3165
US

IV. Provider business mailing address

11 TECHNOLOGY DR
IRVINE CA
92618-2302
US

V. Phone/Fax

Practice location:
  • Phone: 949-453-4308
  • Fax: 949-453-4328
Mailing address:
  • Phone: 949-923-3277
  • Fax: 855-812-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101237526
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA98361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: