Healthcare Provider Details

I. General information

NPI: 1225059306
Provider Name (Legal Business Name): PARHAM GHARAGOZLOU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 WILLOW PASS RD
CONCORD CA
94519-2325
US

IV. Provider business mailing address

3108 WILLOW PASS RD
CONCORD CA
94519-2325
US

V. Phone/Fax

Practice location:
  • Phone: 925-849-6634
  • Fax: 925-849-6635
Mailing address:
  • Phone: 925-849-6634
  • Fax: 925-849-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number246848
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number246848
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA92636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: