Provider Demographics
NPI:1871533679
Name:MAJLESSI, AZADEH LISA (MD)
Entity type:Individual
Prefix:DR
First Name:AZADEH
Middle Name:LISA
Last Name:MAJLESSI
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 1:19582 BEACH BLVD
Mailing Address - Street 2:# 302
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648
Mailing Address - Country:US
Mailing Address - Phone:714-378-2440
Mailing Address - Fax:714-378-2451
Practice Address - Street 1:19582 BEACH BLVD
Practice Address - Street 2:# 302
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2996
Practice Address - Country:US
Practice Address - Phone:714-378-2440
Practice Address - Fax:714-378-2451
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75282207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G752820Medicaid
CAWG75282BMedicare PIN
CAF88588Medicare UPIN