Healthcare Provider Details

I. General information

NPI: 1760574164
Provider Name (Legal Business Name): MAHSHID ELMZADEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 11/16/2025
Certification Date: 11/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5581 ALTON PKWY
IRVINE CA
92618-4056
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 949-453-4308
  • Fax: 949-453-4328
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA73928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: