| Doctor Name: | DR. MASHALLAH EZZATI |
| NPI Number: | 1023011087 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D |
| License Number: | C42933 |
| Business Practice Address: | 23361 El Toro Rd 107 Lake Forest, CA - 926306922 |
| Business Phone Number: | 9492359818 |
| Business Fax Number: | 9493059500 |
| Mailing Address: | 23361 El Toro Rd, 107 LAKE FOREST |
| State: | CA |
| Postal Code: | 926306922 |
| Phone Number: | 9492359818 |
| Fax Number: | 9493059500 |
| NPI Enumeration Date: | 05/24/2005 |
| NPI Last Update Date: | 08/30/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0401X |
| License Number: | C42933 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A family medicine physician who specializes in the diagnosis and treatment of addictions. |