Healthcare Provider Details

I. General information

NPI: 1639784796
Provider Name (Legal Business Name): NAZANIN ALAGHEMAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27725 SANTA MARGARITA PKWY STE 101
MISSION VIEJO CA
92691-6706
US

IV. Provider business mailing address

27725 SANTA MARGARITA PKWY STE 101
MISSION VIEJO CA
92691-6706
US

V. Phone/Fax

Practice location:
  • Phone: 949-270-2100
  • Fax:
Mailing address:
  • Phone: 949-270-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number65821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: