Healthcare Provider Details

I. General information

NPI: 1033213111
Provider Name (Legal Business Name): AROUSHA DAVATGARZADEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 11/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26357 MCBEAN PKWY
VALENCIA CA
91355-4488
US

IV. Provider business mailing address

PO BOX 9602
MISSION HILLS CA
91346-9602
US

V. Phone/Fax

Practice location:
  • Phone: 661-222-2605
  • Fax: 661-222-2694
Mailing address:
  • Phone: 818-837-5637
  • Fax: 818-837-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA92753
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number240730
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: