Healthcare Provider Details

I. General information

NPI: 1417012444
Provider Name (Legal Business Name): MINA ABAZARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 OCEAN AVE
LAGUNA BEACH CA
92651-2322
US

IV. Provider business mailing address

30300 CAMINO CAPISTRANO
SAN JUAN CAPISTRANO CA
92675-1304
US

V. Phone/Fax

Practice location:
  • Phone: 949-557-0610
  • Fax: 949-557-0611
Mailing address:
  • Phone: 949-240-2030
  • Fax: 949-240-5869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA77017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: