Healthcare Provider Details

I. General information

NPI: 1124746318
Provider Name (Legal Business Name): SHAHRZAD ARJOMANDI PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26024 ACERO
MISSION VIEJO CA
92691-2768
US

IV. Provider business mailing address

8 SEMBRADO
RANCHO SANTA MARGARITA CA
92688-2709
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax: 949-609-0374
Mailing address:
  • Phone: 949-201-5970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA62669
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberPA62669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: