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General NPI Number Information
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NPI Number | 1518229806
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Entity Type | Organization
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Legal Business Name | MARIAM MOGHADAM, M.D., INC.
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 81 HIGHLAND SPRINGS AVE. SUITE #306
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City | BEAUMONT
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State | CA
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Zip | 92223-3170
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Country | US
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Telephone | 951-769-2222
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Fax | 951-769-2204
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Provider Business Mailing Address
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Address Line | P.O. BOX 8307
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City | REDLANDS
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State | CA
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Zip | 92375-1507
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Country | US
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Telephone | 951-769-2222
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Fax | 951-769-2204
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIAM SUSAN MOGHADAM
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Credential | M.D.
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Telephone | 951-769-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A86456
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License Number State | CA
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