Healthcare Provider Details

I. General information

NPI: 1508108986
Provider Name (Legal Business Name): BARSAM GHARAGOZLOU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 GLADSTONE DR STE 8
PITTSBURG CA
94565-5125
US

IV. Provider business mailing address

2260 GLADSTONE DR STE 8
PITTSBURG CA
94565-5125
US

V. Phone/Fax

Practice location:
  • Phone: 925-303-4500
  • Fax: 925-517-6500
Mailing address:
  • Phone: 925-267-6000
  • Fax: 925-267-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1123971
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA143860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: