Provider Demographics
NPI:1093037061
Name:NAHID BIRJANDI PODIATRIC INC
Entity type:Organization
Organization Name:NAHID BIRJANDI PODIATRIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRJANDI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-235-6950
Mailing Address - Street 1:27871 MEDICAL CENTER RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6334
Mailing Address - Country:US
Mailing Address - Phone:949-365-1700
Mailing Address - Fax:949-365-0208
Practice Address - Street 1:27871 MEDICAL CENTER RD
Practice Address - Street 2:SUITE 130
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6334
Practice Address - Country:US
Practice Address - Phone:949-365-1700
Practice Address - Fax:949-365-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3841261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E38411Medicaid
CA1508932120OtherNPI TYPE 1
CADB986Medicare PIN
CA1508932120OtherNPI TYPE 1