Organization
MAMAD BAGHERI MD INC
Active
Organization
MAMAD BAGHERI MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAMAD MIRZA BAGHERI M.D. (OWNER/PRESIDENT)
(951) 766-1188
Entity
Organization
Contact information
Practice address
2390 E FLORIDA AVE STE 204, HEMET, CA 92544-4754
(951) 766-1188
(951) 766-1388
Mailing address
PO BOX 5363, HEMET, CA 92544-0363
(951) 766-1188
(951) 766-1388
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A82406
CA
207ND0101X
MOHS-Micrographic Surgery Physician
A82406
CA
207ND0900X
Dermatopathology Physician
A82406
CA
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
A82406
CA
207NP0225X
Pediatric Dermatology Physician
A82406
CA
207NS0135X
Procedural Dermatology Physician
A82406
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112713370
AETNA
—
01
—
A82406
CA LICENSE
CA
01
—
DF1942
RAILROAD MEDICARE
—
01
—
P00346003
RAILROAD MEDICARE
—
Enumeration date
09/28/2006
Last updated
05/24/2013
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