Individual
DR. MASHALLAH EZZATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
23361 EL TORO RD, 107, LAKE FOREST, CA 92630-6922
(949) 235-9818
(949) 305-9500
Mailing address
23361 EL TORO RD, 107, LAKE FOREST, CA 92630-6922
(949) 235-9818
(949) 305-9500
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
C42933
CA
208D00000X
General Practice Physician
Primary
C42933
CA
Other
Enumeration date
05/24/2005
Last updated
08/30/2010
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