Provider Demographics
NPI:1003551615
Name:AFSANEH HAFTBARADARAN MOHAMMADI MD INC
Entity Type:Organization
Organization Name:AFSANEH HAFTBARADARAN MOHAMMADI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSANEH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFTBARADARAN MOHAMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-258-1705
Mailing Address - Street 1:25496 RODEO CIR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5879
Mailing Address - Country:US
Mailing Address - Phone:216-258-1705
Mailing Address - Fax:
Practice Address - Street 1:25411 CABOT RD STE 105
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5517
Practice Address - Country:US
Practice Address - Phone:949-403-5555
Practice Address - Fax:949-403-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty