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General NPI Number Information
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NPI Number | 1003004268
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Entity Type | Organization
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Legal Business Name | ALEXANDER I. ZAMANIAN,M.D. INC.A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 14642 NEWPORT AVE SUITE 310
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City | TUSTIN
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State | CA
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Zip | 92780-6057
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Country | US
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Telephone | 714-368-0696
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Fax | 714-368-0697
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Provider Business Mailing Address
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Address Line | 14642 NEWPORT AVE SUITE 310
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City | TUSTIN
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State | CA
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Zip | 92780-6057
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Country | US
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Telephone | 714-368-0696
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Fax | 714-368-0697
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEXANDER IRAJ ZAMANIAN
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Credential | M.D.
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Telephone | 714-368-0696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | A42243
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License Number State | CA
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