Healthcare Provider Details

I. General information

NPI: 1932373701
Provider Name (Legal Business Name): ELIZABETH HANNAH DELSHAD CAVALIER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH DELSHAD

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG 53, DEPT OF DERMATOLOGY
ORANGE CA
92868-3201
US

IV. Provider business mailing address

101 THE CITY DR S BLDG 53, DEPT OF DERMATOLOGY
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8381
  • Fax: 714-456-8313
Mailing address:
  • Phone: 714-456-8381
  • Fax: 714-456-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA98989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: