Provider Demographics
NPI:1548146178
Name:JALALI, MAHTAB FARAHANI (DPT, PT)
Entity type:Individual
Prefix:
First Name:MAHTAB
Middle Name:FARAHANI
Last Name:JALALI
Suffix:
Gender:X
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 ALABAMA CIR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2029
Mailing Address - Country:US
Mailing Address - Phone:714-406-3447
Mailing Address - Fax:714-333-4699
Practice Address - Street 1:3324 ALABAMA CIR
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2029
Practice Address - Country:US
Practice Address - Phone:714-406-3447
Practice Address - Fax:714-333-4699
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist