Healthcare Provider Details

I. General information

NPI: 1285753871
Provider Name (Legal Business Name): PARVIN BAGHERI PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6991 BALBOA AVE
SAN DIEGO CA
92111-3447
US

IV. Provider business mailing address

6991 BALBOA AVE
SAN DIEGO CA
92111-3447
US

V. Phone/Fax

Practice location:
  • Phone: 858-496-8232
  • Fax:
Mailing address:
  • Phone: 858-496-8232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT 18966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: