Provider Demographics
NPI:1306895974
Name:SEYFZADEH, MANOUCHEHR (MD, PHD)
Entity type:Individual
Prefix:MR
First Name:MANOUCHEHR
Middle Name:
Last Name:SEYFZADEH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25422 TRABUCO RD STE 105-333
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2791
Mailing Address - Country:US
Mailing Address - Phone:949-855-4439
Mailing Address - Fax:888-978-2187
Practice Address - Street 1:1820 FULLERTON AVENUE
Practice Address - Street 2:STE 360
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3106
Practice Address - Country:US
Practice Address - Phone:951-270-4494
Practice Address - Fax:951-270-4495
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA062453207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA62453BOtherPPIN
CAWA62453BOtherPPIN