Healthcare Provider Details

I. General information

NPI: 1740448414
Provider Name (Legal Business Name): HOMAYON IRANINEZHAD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 AVENIDA PICO STE 130
SAN CLEMENTE CA
92673-3908
US

IV. Provider business mailing address

993 AVENIDA PICO STE 130
SAN CLEMENTE CA
92673-3908
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-7569
  • Fax: 949-764-7568
Mailing address:
  • Phone: 949-764-7569
  • Fax: 949-764-7568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number12394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: