Provider Demographics
NPI:1154609238
Name:MIRZANIA, HAMIDREZA (MD)
Entity type:Individual
Prefix:DR
First Name:HAMIDREZA
Middle Name:
Last Name:MIRZANIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27641 ROSEBUD WAY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:240-778-5734
Mailing Address - Fax:
Practice Address - Street 1:7916 EASTERN AVE.
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201
Practice Address - Country:US
Practice Address - Phone:714-852-3311
Practice Address - Fax:714-617-4935
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-24
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA150750208600000X
PAMD448837208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery