1275742041 NPI number — DR. HABIBOLLAH MERZAD SADEGHI D.O.

Table of content: (NPI 1326808635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275742041 NPI number — DR. HABIBOLLAH MERZAD SADEGHI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SADEGHI
Provider First Name:
HABIBOLLAH
Provider Middle Name:
MERZAD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SADEGHI
Provider Other First Name:
HABIB
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1275742041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28632 ROADSIDE DR
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
AGOURA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-452-4483
Provider Business Mailing Address Fax Number:
818-452-4488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28632 ROADSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
AGOURA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-452-4483
Provider Business Practice Location Address Fax Number:
818-452-4488
Provider Enumeration Date:
05/21/2007

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: 207Q00000X , with the licence number:  20A8718 , 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)





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