Individual
MISSRA REZVANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1010 W LA VETA AVE, STE 750, ORANGE, CA 92868-4300
(714) 361-6600
Mailing address
1310 W STEWART DR, STE 410, ORANGE, CA 92868-3854
(714) 639-9401
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
19140
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19140
MEDICAL LICENSE (NP)
CA
01
—
670627
MEDICAL LICENSE (RN)
CA
Enumeration date
07/22/2010
Last updated
09/20/2010
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