Healthcare Provider Details

I. General information

NPI: 1366377343
Provider Name (Legal Business Name): TAHEREH FOTOVVATI BOROUJERDI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 GATEWAY UNIT 3353
IRVINE CA
92618-5851
US

IV. Provider business mailing address

7725 GATEWAY
IRVINE CA
92618-1599
US

V. Phone/Fax

Practice location:
  • Phone: 949-880-6200
  • Fax:
Mailing address:
  • Phone: 949-880-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: