Healthcare Provider Details

I. General information

NPI: 1598502437
Provider Name (Legal Business Name): MAZIYAR MOHSENPOUR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 AVENIDA VAQUERO STE D
SAN CLEMENTE CA
92672-3631
US

IV. Provider business mailing address

308 W CHAPMAN AVE #143
ORANGE CA
92856
US

V. Phone/Fax

Practice location:
  • Phone: 949-218-4750
  • Fax: 949-276-7396
Mailing address:
  • Phone: 424-371-3077
  • Fax: 424-371-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number37581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: