MEDICARE: DR. HAGOS HABTEZGHI MD

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	207Q00000X	Family Medicine Physician	C41500	CA

General Provider Information

NPI Number	:	1235289679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAGOS HABTEZGHI MD

Provider Business Mailing Address
First Line	:	3334 HEATHER FIELD DR
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-6137
Country	:	US
Telephone Number	:	323-835-8401
Fax Number	:

Provider Business Practice Location Address
First Line	:	9901 COMPTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90002-2850
Country	:	US
Telephone Number	:	323-835-8401
Fax Number	:	323-835-8405

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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