MEDICARE: ALIREZA MIRZABOZORG 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	207Q00000X	Family Medicine Physician	A43569	CA

General Provider Information

NPI Number	:	1932100120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIREZA MIRZABOZORG M.D.

Provider Business Mailing Address
First Line	:	710 N EUCLID ST
Second Line	:	SUITE 214
City	:	ANAHEIM
State	:	CA
Zip	:	92801-4122
Country	:	US
Telephone Number	:	714-522-2891
Fax Number	:	714-522-3401

Provider Business Practice Location Address
First Line	:	710 N EUCLID ST
Second Line	:	SUITE 214
City	:	ANAHEIM
State	:	CA
Zip	:	92801-4122
Country	:	US
Telephone Number	:	714-522-2891
Fax Number	:	714-522-3401

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/22/2016

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