Healthcare Provider Details

I. General information

NPI: 1730791864
Provider Name (Legal Business Name): REZA SHAHBAZ, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E CHAPMAN AVE
ORANGE CA
92869-3206
US

IV. Provider business mailing address

402 ROCKEFELLER UNIT 214
IRVINE CA
92612-8105
US

V. Phone/Fax

Practice location:
  • Phone: 949-800-9744
  • Fax:
Mailing address:
  • Phone: 979-800-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: REZA SHAHBAZ
Title or Position: OWNER
Credential: MD
Phone: 949-800-9744