Organization
A. ETEMADI MD, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAHNAZ LEWIS (BILLING MANAGER)
(949) 495-1416
Entity
Organization
Contact information
Practice address
24881 ALICIA PKWY STE N, LAGUNA HILLS, CA 92653-4617
(949) 510-2259
(949) 388-3336
Mailing address
24881 ALICIA PKWY STE N, LAGUNA HILLS, CA 92653-4617
(949) 510-2259
(949) 388-3336
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G67093
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G670930
—
CA
01
—
G67093
CA STATE LICENSE
CA
01
—
ZZZ56190Y
BLUE SHIELD
CA
Enumeration date
01/28/2009
Last updated
02/09/2010
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