Provider Demographics
NPI:1215909486
Name:SAZGAR, MONA (MD)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:SAZGAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 THE CITY DR S
Mailing Address - Street 2:PAVILION I, FIRST FLOOR
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3201
Mailing Address - Country:US
Mailing Address - Phone:714-456-6510
Mailing Address - Fax:714-456-6908
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:PAVILION I, FIRST FLOOR
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-6510
Practice Address - Fax:714-456-6908
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC543002084N0600X, 2084N0400X, 2084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02560492Medicaid
NYH73105Medicare UPIN
NY02560492Medicaid
NYRB0904Medicare PIN