Provider Demographics
NPI:1427932540
Name:MANESH, HEDI
Entity type:Individual
Prefix:
First Name:HEDI
Middle Name:
Last Name:MANESH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEDIEH
Other - Middle Name:
Other - Last Name:BOZORGMANESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28 SKYGATE
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1820
Mailing Address - Country:US
Mailing Address - Phone:949-887-9829
Mailing Address - Fax:
Practice Address - Street 1:28 SKYGATE
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-1820
Practice Address - Country:US
Practice Address - Phone:949-887-9829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZ134780363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner