Healthcare Provider Details

I. General information

NPI: 1790955052
Provider Name (Legal Business Name): FARAMARZ ALIZADEH-SHABDIZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE SUITE 520
ORANGE CA
92868-4225
US

IV. Provider business mailing address

PO BOX 5971
ORANGE CA
92863-5971
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-2000
  • Fax:
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA101653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: