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General NPI Number Information
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NPI Number | 1780818625
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Entity Type | Individual
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Provider Name | MICHAEL MAZIYAR IZADI PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 2081 BUSINESS CENTER DR SUITE 109
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City | IRVINE
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State | CA
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Zip | 92612-1119
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Country | US
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Telephone | 949-374-3365
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Fax | 949-716-7313
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Provider Business Mailing Address
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Address Line | 28241 CROWN VALLEY PKWY SUITE F #182
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-4441
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Country | US
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Telephone | 949-374-3365
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY28092
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License Number State | CA
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