Healthcare Provider Details

I. General information

NPI: 1588004634
Provider Name (Legal Business Name): FERESHTEH HAJSADEGHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23206 LYONS AVE STE 209
SANTA CLARITA CA
91321-2672
US

IV. Provider business mailing address

20757 BERMUDA ST
CHATSWORTH CA
91311-1502
US

V. Phone/Fax

Practice location:
  • Phone: 562-852-0099
  • Fax:
Mailing address:
  • Phone: 562-852-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125063271
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA137974
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberA137974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: