Basic Information
| Provider Information | |||||||||
| NPI: | 1619521556 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAFAVI | ||||||||
| FirstName: | MAHSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9304 VIRTUOSO | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926200368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4163180188 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 CORPORATE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LADERA RANCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926941153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493649112 | ||||||||
| FaxNumber: | 9493649016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2019 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C160553 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.