Provider Demographics
NPI:1114720612
Name:GAROOSI, KASSRA B
Entity type:Individual
Prefix:
First Name:KASSRA
Middle Name:B
Last Name:GAROOSI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28071 HIBISCUS DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7004
Mailing Address - Country:US
Mailing Address - Phone:949-466-3452
Mailing Address - Fax:
Practice Address - Street 1:28071 HIBISCUS DR
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7004
Practice Address - Country:US
Practice Address - Phone:949-466-3452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program