Healthcare Provider Details

I. General information

NPI: 1295391712
Provider Name (Legal Business Name): BAGHERPOUR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70077 RAMON RD STE 1
RANCHO MIRAGE CA
92270-5201
US

IV. Provider business mailing address

70077 RAMON RD STE 1
RANCHO MIRAGE CA
92270-5201
US

V. Phone/Fax

Practice location:
  • Phone: 760-895-6557
  • Fax: 760-895-6601
Mailing address:
  • Phone: 760-895-6557
  • Fax: 760-895-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: REZA BAGHERPOUR
Title or Position: OWNER
Credential: MD
Phone: 949-878-6666