Healthcare Provider Details

I. General information

NPI: 1558691451
Provider Name (Legal Business Name): MOZHGAN ASHTARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23141 MOULTON PKWY 202
LAGUNA HILLS CA
92653-1241
US

IV. Provider business mailing address

23141 MOULTON PKWY STE 202
LAGUNA HILLS CA
92653-1241
US

V. Phone/Fax

Practice location:
  • Phone: 949-600-6334
  • Fax: 949-600-6454
Mailing address:
  • Phone: 949-600-6334
  • Fax: 949-600-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA111582
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA111582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: