Healthcare Provider Details

I. General information

NPI: 1548384746
Provider Name (Legal Business Name): MORTEZA SAJADIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 05/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N ORANGE GROVE AVE SUITE 202
POMONA CA
91767-3028
US

IV. Provider business mailing address

PO BOX 2016
YORBA LINDA CA
92885-1216
US

V. Phone/Fax

Practice location:
  • Phone: 909-865-3000
  • Fax: 909-865-6223
Mailing address:
  • Phone: 714-218-1829
  • Fax: 714-777-8967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC42140
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberHC42140
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberHC42140
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHC42140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: