=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043176852
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIMI VALLEY RETINA SPECIALISTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/25/2025
-----------------------------------------------------
Last Update Date | 12/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1687 ERRINGER RD STE 102
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93065-6509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-330-1482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1687 ERRINGER RD STE 102
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93065-6509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | NIKA BAGHERI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-292-0946
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207WX0107X
-----------------------------------------------------
Taxonomy Name | Retina Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------