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General NPI Number Information
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NPI Number | 1578512737
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Entity Type | Individual
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Provider Name | NADIA REZAIAMIRI D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 31734 RANCHO VIEJO RD
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2782
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Country | US
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Telephone | 949-496-2930
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Fax | 949-496-2962
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Provider Business Mailing Address
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Address Line | 19 ALTIMIRA
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City | COTO DE CAZA
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State | CA
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Zip | 92679-4901
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Country | US
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Telephone | 949-350-3457
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | B42405
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License Number State | CA
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