Healthcare Provider Details

I. General information

NPI: 1689565244
Provider Name (Legal Business Name): ANGELO SADEGHPOUR MD PHD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081 SALZEDO ST STE 202AA
CORAL GABLES FL
33134-6722
US

IV. Provider business mailing address

3081 SALZEDO ST STE 202AA
CORAL GABLES FL
33134-6722
US

V. Phone/Fax

Practice location:
  • Phone: 305-900-4543
  • Fax: 305-686-1752
Mailing address:
  • Phone: 305-900-4543
  • Fax: 305-686-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANGELO SADEGHPOUR
Title or Position: MEMBER
Credential: MD PHD
Phone: 310-906-8889