Individual
AZITA MAVANDADI
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
19066 MAGNOLIA ST, HUNTINGTON BEACH, CA 92646-2232
(714) 968-0068
(714) 378-2188
Mailing address
4607 FAIRFIELD DR, CORONA DEL MAR, CA 92625-3110
(949) 640-6330
Taxonomy
Speciality
Code
Description
License number
State
208U00000X
Clinical Pharmacology Physician
Primary
49724
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0497240
MEDI CAL
CA
Enumeration date
07/01/2005
Last updated
07/08/2007
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