Healthcare Provider Details

I. General information

NPI: 1467242123
Provider Name (Legal Business Name): SANAZ MOGHADDAMIMONAGHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

1 AMALFI
ALISO VIEJO CA
92656-5239
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-7911
  • Fax: 410-955-0374
Mailing address:
  • Phone: 213-215-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number-
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: