Healthcare Provider Details

I. General information

NPI: 1780818625
Provider Name (Legal Business Name): MICHAEL MAZIYAR IZADI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28241 CROWN VALLEY PKWY # F155
LAGUNA NIGUEL CA
92677-4441
US

IV. Provider business mailing address

28241 CROWN VALLEY PKWY # F155
LAGUNA NIGUEL CA
92677-4441
US

V. Phone/Fax

Practice location:
  • Phone: 949-212-6372
  • Fax:
Mailing address:
  • Phone: 949-212-6372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: