Healthcare Provider Details

I. General information

NPI: 1659515252
Provider Name (Legal Business Name): MERCEDEH BAGHAI M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23600 TELO AVE STE 150
TORRANCE CA
90505-4039
US

IV. Provider business mailing address

21143 HAWTHORNE BLVD # 512
TORRANCE CA
90503-4615
US

V. Phone/Fax

Practice location:
  • Phone: 310-802-6260
  • Fax:
Mailing address:
  • Phone: 310-543-9160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA94732
License Number StateCA

VIII. Authorized Official

Name: MERCEDEH BAGHAI
Title or Position: OWNER
Credential: M.D.
Phone: 310-543-9160