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NPI Code Detail

MEDICARE: MRS. FARZANEH HANITABATABAEI DDS

MEDICARE: MRS. FARZANEH HANITABATABAEI DDS
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
1122300000XDentist56315CA

General Provider Information

NPI Number : 1730458712
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. FARZANEH HANITABATABAEI DDS
Provider Business Mailing Address
First Line : PO BOX 14473
Second Line :
City : IRVINE
State : CA
Zip : 92623-4473
Country : US
Telephone Number : 949-407-4334
Fax Number :
Provider Business Practice Location Address
First Line : 11702 BEACH BLVD
Second Line :
City : STANTON
State : CA
Zip : 90680-3609
Country : US
Telephone Number : 714-898-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2011
Last Update Date : 09/13/2012

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