Provider Demographics
NPI:1043279722
Name:MOZAYENI, PANTEA (MD)
Entity type:Individual
Prefix:
First Name:PANTEA
Middle Name:
Last Name:MOZAYENI
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 1:4050 BARRANCA PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1723
Mailing Address - Country:US
Mailing Address - Phone:949-559-1911
Mailing Address - Fax:949-559-4071
Practice Address - Street 1:4050 BARRANCA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1723
Practice Address - Country:US
Practice Address - Phone:949-559-1911
Practice Address - Fax:949-559-4071
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78866207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH69320Medicare UPIN