Healthcare Provider Details

I. General information

NPI: 1962601047
Provider Name (Legal Business Name): MOHAMMADBAGHER ZIARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 CORONA POINTE CT STE 112
CORONA CA
92879-1770
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 951-898-2828
  • Fax:
Mailing address:
  • Phone: 626-775-3514
  • Fax: 626-218-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number48712
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA118844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: