Healthcare Provider Details

I. General information

NPI: 1104846955
Provider Name (Legal Business Name): VAHID MISSAGHI M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11518 GARVEY AVE
EL MONTE CA
91732-3306
US

IV. Provider business mailing address

11518 GARVEY AVE
EL MONTE CA
91732-3306
US

V. Phone/Fax

Practice location:
  • Phone: 626-575-4584
  • Fax: 626-575-0882
Mailing address:
  • Phone: 626-575-4584
  • Fax: 626-575-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA63241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: