Healthcare Provider Details

I. General information

NPI: 1508109018
Provider Name (Legal Business Name): ALIREZA BOZORGI M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E 1ST ST STE B
TUSTIN CA
92780-3335
US

IV. Provider business mailing address

3972 BARRANCA PKWY STE J432
IRVINE CA
92606-1204
US

V. Phone/Fax

Practice location:
  • Phone: 714-819-0000
  • Fax: 714-406-3630
Mailing address:
  • Phone: 714-819-0000
  • Fax: 714-406-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA179347
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberA179347
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberA179347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: