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General NPI Number Information
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NPI Number | 1447116942
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Entity Type | Individual
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Provider Name | OMID MAZAHERI
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Gender | Male
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 1207 E FRUIT ST
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City | SANTA ANA
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State | CA
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Zip | 92701-4296
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Country | US
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Telephone | 201-877-6676
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Fax |
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Provider Business Mailing Address
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Address Line | 13682 UTT DR APT B
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City | TUSTIN
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State | CA
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Zip | 92780-4581
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Country | US
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Telephone | 201-877-6676
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Fax | 201-877-6676
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | RT1421341025
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License Number State | CA
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