1275514986 NPI number — DR. BEHZAD TAGHIZADEH M.D.

Table of content: DR. BEHZAD TAGHIZADEH M.D. (NPI 1275514986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275514986 NPI number — DR. BEHZAD TAGHIZADEH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAGHIZADEH
Provider First Name:
BEHZAD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275514986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5555 RESERVOIR DR STE 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92120-5186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-414-6079
Provider Business Mailing Address Fax Number:
858-771-1534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5555 RESERVOIR DR STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92120-5186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-414-6079
Provider Business Practice Location Address Fax Number:
858-771-1534
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  200300293 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 0101232582 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: C58208 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010117321 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010117364 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010116716 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 167205 . This is a "ANTHEM (W/S)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2012405A . This is a "FMH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3155493 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 010117313 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3069114 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7275230 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010117330 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 167299 . This is a "ANTHEM (MOCKSVILLE)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 13338 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1275514986 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166458 . This is a "ANTHEM (STUART)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 166719 . This is a "ANTHEM (MT. AIRY)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 166007 . This is a "ANTHEM (GALAX)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 8913338 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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