Provider Demographics
NPI:1851773527
Name:MORADI, REZA
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:MORADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AHMADREZA
Other - Middle Name:
Other - Last Name:MORADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:20072 SW BIRCH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0799
Mailing Address - Country:US
Mailing Address - Phone:949-270-6063
Mailing Address - Fax:949-270-6064
Practice Address - Street 1:20072 SW BIRCH ST STE 210
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0799
Practice Address - Country:US
Practice Address - Phone:949-270-6063
Practice Address - Fax:949-270-6064
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157047207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist