# MARIAM MOGHADAM, M.D., INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518229806
- **Authorized official:** MARIAM SUSAN MOGHADAM M.D. (PRESIDENT)
- **Authorized official phone:** (951) 769-2222

## Contact information

- **Practice address:** 81 HIGHLAND SPRINGS AVE., SUITE \#306, BEAUMONT, CA 92223-3170
- **Practice address phone:** (951) 769-2222
- **Practice address fax:** (951) 769-2204
- **Mailing address:** P.O. BOX 8307, REDLANDS, CA 92375-1507
- **Mailing address phone:** (951) 769-2222
- **Mailing address fax:** (951) 769-2204

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | A86456 | CA | Yes |

## Other

- **Enumeration date:** 06/12/2012
- **Last updated:** 03/07/2023