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General NPI Number Information
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NPI Number | 1083887202
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY PRACTICE SPECIALTY, INC.
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 4950 BARRANCA PKWY STE 111
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City | IRVINE
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State | CA
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Zip | 92604-4630
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Country | US
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Telephone | 949-654-0660
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Fax | 949-654-0640
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Provider Business Mailing Address
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Address Line | 4950 BARRANCA PKWY. SUITE 111
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City | IRVINE
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State | CA
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Zip | 92604-4630
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Country | US
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Telephone | 949-654-0660
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Fax | 949-654-0640
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. MAHSHID ELMZADEH
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Credential | M.D.
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Telephone | 949-654-0660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0A73928
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License Number State | CA
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