MEDICARE: MINA ABAZARI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	A77017	CA

General Provider Information

NPI Number	:	1417012444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINA ABAZARI M.D.

Provider Business Mailing Address
First Line	:	30300 CAMINO CAPISTRANO
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1304
Country	:	US
Telephone Number	:	949-240-2030
Fax Number	:	949-240-5869

Provider Business Practice Location Address
First Line	:	370 OCEAN AVE
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2322
Country	:	US
Telephone Number	:	949-557-0610
Fax Number	:	949-557-0611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	05/29/2026

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