Healthcare Provider Details

I. General information

NPI: 1518685650
Provider Name (Legal Business Name): BITA ADIB BAGHERI MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE 335
NEWPORT BEACH CA
92663-3672
US

IV. Provider business mailing address

520 SUPERIOR AVE STE 335
NEWPORT BEACH CA
92663-3672
US

V. Phone/Fax

Practice location:
  • Phone: 949-236-7900
  • Fax: 949-236-7900
Mailing address:
  • Phone: 949-236-7900
  • Fax: 949-236-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BITA BAGHERI
Title or Position: OWNER
Credential:
Phone: 949-236-7900