MEDICARE: TAHA GHOLIPOUR 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	2084N0400X	Neurology Physician	0101264640	VA
2	2084N0400X	Neurology Physician	C187602	CA
3	2084N0600X	Clinical Neurophysiology Physician	MD046311	DC
4	2084E0001X	Epilepsy Physician	C187602	CA
5	2084N0600X	Clinical Neurophysiology Physician	0101264640	VA

General Provider Information

NPI Number	:	1801159611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAHA GHOLIPOUR MD

Provider Business Mailing Address
First Line	:	FILE 57326
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-7326
Country	:	US
Telephone Number	:	858-249-6748
Fax Number	:

Provider Business Practice Location Address
First Line	:	9350 CAMPUS POINT DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92037-1300
Country	:	US
Telephone Number	:	858-657-7000
Fax Number	:

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

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	07/26/2024

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Directions to “ TAHA GHOLIPOUR MD” Practice Location

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