Healthcare Provider Details

I. General information

NPI: 1871084848
Provider Name (Legal Business Name): MRS. SARVA ZAMANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 N TUSTIN ST
ORANGE CA
92867-7716
US

IV. Provider business mailing address

2222 MICHELSON DR STE 222-333
IRVINE CA
92612-1332
US

V. Phone/Fax

Practice location:
  • Phone: 714-598-3923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: