Healthcare Provider Details

I. General information

NPI: 1780773721
Provider Name (Legal Business Name): HMA MAHDAVI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOMA MAHDAVI PEZESHKIAN M.D.

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 TERMINO AVE STE 214
LONG BEACH CA
90804-2169
US

IV. Provider business mailing address

6101 BALL RD STE 310
CYPRESS CA
90630-3966
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-6933
  • Fax: 562-933-6939
Mailing address:
  • Phone: 714-220-9486
  • Fax: 714-220-9481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberA72759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: