Healthcare Provider Details

I. General information

NPI: 1154806792
Provider Name (Legal Business Name): NAGHMEH RAMEZANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2018
Last Update Date: 09/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24330 EL TORO RD
LAGUNA WOODS CA
92637-2775
US

IV. Provider business mailing address

21811 LANAR
MISSION VIEJO CA
92692-1041
US

V. Phone/Fax

Practice location:
  • Phone: 949-830-0391
  • Fax:
Mailing address:
  • Phone: 949-690-0498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: