Provider Demographics
NPI:1104583384
Name:ESMAILI, MAHNOUSH
Entity type:Individual
Prefix:DR
First Name:MAHNOUSH
Middle Name:
Last Name:ESMAILI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22702 PACIFIC PARK DR APT A26
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-7101
Mailing Address - Country:US
Mailing Address - Phone:917-861-8983
Mailing Address - Fax:
Practice Address - Street 1:22702 PACIFIC PARK DR APT A26
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-7101
Practice Address - Country:US
Practice Address - Phone:917-861-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19315171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty