Healthcare Provider Details

I. General information

NPI: 1700298965
Provider Name (Legal Business Name): NAZANIN MINOUEI PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 N. TUSTIN AVE
ORANGE CA
92867
US

IV. Provider business mailing address

1045 N. TUSTIN AVE
ORANGE CA
92867
US

V. Phone/Fax

Practice location:
  • Phone: 714-288-8303
  • Fax: 714-744-8153
Mailing address:
  • Phone: 714-288-8303
  • Fax: 714-744-8153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT 10192
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA 3354
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: