MEDICARE: DR. NIMA ALEAGHA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	55987	CA

General Provider Information

NPI Number	:	1174713937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIMA ALEAGHA D.D.S.

Provider Business Mailing Address
First Line	:	5635 BUFFWOOD PL
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1581
Country	:	US
Telephone Number	:	818-687-2209
Fax Number	:	818-888-6876

Provider Business Practice Location Address
First Line	:	1459 E THOUSAND OAKS BLVD STE A1
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91362-6223
Country	:	US
Telephone Number	:	805-494-1831
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	11/20/2019

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