Healthcare Provider Details

I. General information

NPI: 1417132705
Provider Name (Legal Business Name): MAHIN ZANDIZADEH ESFAHANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3392 MOTOR AVE
LOS ANGELES CA
90034-3712
US

IV. Provider business mailing address

1900 E OCEAN BLVD APT 1504
LONG BEACH CA
90802-6100
US

V. Phone/Fax

Practice location:
  • Phone: 310-858-5090
  • Fax: 310-424-3404
Mailing address:
  • Phone: 818-674-2890
  • Fax: 310-424-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA31491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: