Healthcare Provider Details

I. General information

NPI: 1144683137
Provider Name (Legal Business Name): MOHAMMAD REZA HAJIGHASEMI-OSSAREH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOHAMMAD BRAVO HAJIGHASEMI

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17360 BROOKHURST STREET
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

17360 BROOKHURST STREET
FOUNTAIN VALLEY CA
92708
US

V. Phone/Fax

Practice location:
  • Phone: 877-844-0012
  • Fax: 714-665-4680
Mailing address:
  • Phone: 877-844-0012
  • Fax: 714-665-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101272074
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2021-02711
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number63148
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA150719
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number88488
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberTPME1293
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number55605
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: