Healthcare Provider Details

I. General information

NPI: 1144553272
Provider Name (Legal Business Name): DANIEL S MOGHADAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 E HICKORY AVE
LOMPOC CA
93436-7318
US

IV. Provider business mailing address

3916 STATE ST #300
SANTA BARBARA CA
93105-5602
US

V. Phone/Fax

Practice location:
  • Phone: 805-737-3333
  • Fax:
Mailing address:
  • Phone: 805-563-3011
  • Fax: 805-564-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA109217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: