Healthcare Provider Details

I. General information

NPI: 1215909486
Provider Name (Legal Business Name): MONA SAZGAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S PAVILION I, FIRST FLOOR
ORANGE CA
92868-3201
US

IV. Provider business mailing address

101 THE CITY DR S PAVILION I, FIRST FLOOR
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-6510
  • Fax: 714-456-6908
Mailing address:
  • Phone: 714-456-6510
  • Fax: 714-456-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberC54300
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC54300
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberC54300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: