Healthcare Provider Details

I. General information

NPI: 1194083105
Provider Name (Legal Business Name): MERSEDEH BAHR HOSSEINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 RIVERBEND DR. NEUROHOSPITALISTS
SPRINGFIELD OR
97477
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-5144
  • Fax: 541-338-1070
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA137503
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD187494
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: