Healthcare Provider Details

I. General information

NPI: 1730767773
Provider Name (Legal Business Name): PARVANEH VAZIRI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUPERIOR AVE STE 160
NEWPORT BEACH CA
92663-3677
US

IV. Provider business mailing address

500 SUPERIOR AVE STE 160
NEWPORT BEACH CA
92663-3677
US

V. Phone/Fax

Practice location:
  • Phone: 949-791-3006
  • Fax:
Mailing address:
  • Phone: 949-791-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA192990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: