Healthcare Provider Details

I. General information

NPI: 1346273810
Provider Name (Legal Business Name): RAMYAR MOUSSAVI D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 IRVINE BLVD SUITE 125
TUSTIN CA
92780
US

IV. Provider business mailing address

1442 IRVINE BLVD SUITE 125
TUSTIN CA
92780
US

V. Phone/Fax

Practice location:
  • Phone: 714-544-1600
  • Fax: 714-544-8855
Mailing address:
  • Phone: 714-544-1600
  • Fax: 714-544-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: