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General NPI Number Information
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NPI Number | 1518760560
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Entity Type | Organization
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Legal Business Name | MITRA FATOURECHI-ALSHARIF, PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 275 VICTORIA ST STE 2F
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City | COSTA MESA
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State | CA
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Zip | 92627-1906
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Country | US
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Telephone | 949-650-0630
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Fax | 949-650-3754
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Provider Business Mailing Address
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Address Line | 275 VICTORIA ST STE 2F
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City | COSTA MESA
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State | CA
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Zip | 92627-1906
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Country | US
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Telephone | 949-650-0630
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR, PRESIDENT
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Name | MITRA FATOURECHI-ALSHARIF
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Credential | MD
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Telephone | 949-650-0630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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