MEDICARE: SAEEDEH BABAESFAHANI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1003523010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAEEDEH BABAESFAHANI

Provider Business Mailing Address
First Line	:	7 STRAUSS TER
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-4075
Country	:	US
Telephone Number	:	760-636-6917
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 STRAUSS TER
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-4075
Country	:	US
Telephone Number	:	760-636-6917
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	10/31/2022

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