Healthcare Provider Details

I. General information

NPI: 1477802148
Provider Name (Legal Business Name): RAZIEH HADIAN JAZI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 CULVER DRIVE, STE. 100
IRVINE CA
92604
US

IV. Provider business mailing address

14150 CULVER DRIVE, STE. 100
IRVINE CA
92604
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-4584
  • Fax: 949-551-5612
Mailing address:
  • Phone: 949-552-4584
  • Fax: 949-551-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC162616
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number63080-02
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: