Provider Demographics
NPI:1447546106
Name:IZADI, ATEFEH (DPM)
Entity type:Individual
Prefix:
First Name:ATEFEH
Middle Name:
Last Name:IZADI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:FAYE
Other - Middle Name:
Other - Last Name:IZADI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:13556 RANCHO DEL AZALEAS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5659
Mailing Address - Country:US
Mailing Address - Phone:619-948-5997
Mailing Address - Fax:
Practice Address - Street 1:550 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 209
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5999
Practice Address - Country:US
Practice Address - Phone:562-493-2451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEL1879213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist