Healthcare Provider Details

I. General information

NPI: 1669328191
Provider Name (Legal Business Name): MEHRNOOSH MAALHAGHFARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST
LITTLE ROCK AR
72205-7199
US

IV. Provider business mailing address

624 HILGARD AVE
LOS ANGELES CA
90024-3225
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-8000
  • Fax:
Mailing address:
  • Phone: 310-490-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberT2026-022
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: