Healthcare Provider Details

I. General information

NPI: 1790027183
Provider Name (Legal Business Name): BAHRAM TROY MOGHADAM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TROY MOGHADAM DPM

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 VISTA WAY # 210
OCEANSIDE CA
92054-5661
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 760-704-5750
  • Fax:
Mailing address:
  • Phone: 760-704-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: