Healthcare Provider Details

I. General information

NPI: 1700319084
Provider Name (Legal Business Name): RUZBEH MOSADEGHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 DIVISADERO ST STE 120
SAN FRANCISCO CA
94115-3011
US

IV. Provider business mailing address

1701 DIVISADERO ST STE 120
SAN FRANCISCO CA
94115-3011
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-4444
  • Fax: 415-502-2249
Mailing address:
  • Phone: 415-502-4444
  • Fax: 415-502-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA161709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: