Healthcare Provider Details

I. General information

NPI: 1811176720
Provider Name (Legal Business Name): SHAHRZAD SHAREGHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2876 SYCAMORE DR STE 201
SIMI VALLEY CA
93065-1550
US

IV. Provider business mailing address

2876 SYCAMORE DR STE 201
SIMI VALLEY CA
93065-1550
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-6616
  • Fax:
Mailing address:
  • Phone: 805-527-6616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA87664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: