Provider Demographics
NPI:1588766455
Name:DARANI, MANUCHEHR M (MD)
Entity type:Individual
Prefix:
First Name:MANUCHEHR
Middle Name:M
Last Name:DARANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MANUCHEHR
Other - Middle Name:M
Other - Last Name:DARANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 11593
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5035
Mailing Address - Country:US
Mailing Address - Phone:714-957-2738
Mailing Address - Fax:714-957-1758
Practice Address - Street 1:3620 S BRISTOL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7300
Practice Address - Country:US
Practice Address - Phone:714-957-2738
Practice Address - Fax:714-957-1758
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29675207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29675OtherSTATE LICENSE
CAB50111Medicare UPIN
CAW6180Medicare ID - Type Unspecified