MEDICARE: ESRAFIL ABEDI M D A PROFESSIONAL CORPORATION

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	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	A30818	CA

General Provider Information

NPI Number	:	1447500269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESRAFIL ABEDI M D A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	23961 CALLE MAGDALENA
Second Line	:	430
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3685
Country	:	US
Telephone Number	:	949-470-0600
Fax Number	:	949-830-1095

Provider Business Practice Location Address
First Line	:	23961 CALLE MAGDALENA ST
Second Line	:	430
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3685
Country	:	US
Telephone Number	:	949-470-0600
Fax Number	:	949-830-1095

Authorized Official
Title or Position	:	OWNER
Name	:	ESRAFIL ABEDI
Credential	:	M.D.
Telephone Number	:	949-470-0600

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	07/23/2024

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