Provider Demographics
NPI:1154362499
Name:TABRIZI, PEYMAN
Entity type:Individual
Prefix:
First Name:PEYMAN
Middle Name:
Last Name:TABRIZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1161
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-1161
Mailing Address - Country:US
Mailing Address - Phone:949-448-0302
Mailing Address - Fax:949-448-0335
Practice Address - Street 1:1220 HEMLOCK WAY STE 205
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3655
Practice Address - Country:US
Practice Address - Phone:714-834-0439
Practice Address - Fax:714-953-3425
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61388207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19505Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER