Provider Demographics
NPI:1699972844
Name:MEHRABIAN, HOMEIRA (MD)
Entity type:Individual
Prefix:
First Name:HOMEIRA
Middle Name:
Last Name:MEHRABIAN
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 1:361 HOSPITAL RD
Mailing Address - Street 2:STE 331
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3522
Mailing Address - Country:US
Mailing Address - Phone:949-645-8300
Mailing Address - Fax:949-645-0200
Practice Address - Street 1:361 HOSPITAL RD
Practice Address - Street 2:STE 331
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3522
Practice Address - Country:US
Practice Address - Phone:949-645-8300
Practice Address - Fax:949-645-0200
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53225207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A532250Medicaid
CAG57562Medicare UPIN