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Individual
SHAHRAM MOGHADASI
Active
Individual
SHAHRAM MOGHADASI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15877
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCP70468F
CDC GRP#
CA
05
—
FHC70468F
—
CA
01
—
HAP70468F
HAP GRP #
CA
01
—
PA15877
LICENSE #
CA
Enumeration date
08/31/2006
Last updated
07/09/2007
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