Provider Demographics
NPI:1104846955
Name:MISSAGHI, VAHID (MD,)
Entity Type:Individual
Prefix:
First Name:VAHID
Middle Name:
Last Name:MISSAGHI
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11518 GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3306
Mailing Address - Country:US
Mailing Address - Phone:626-575-4584
Mailing Address - Fax:626-575-0882
Practice Address - Street 1:11518 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3306
Practice Address - Country:US
Practice Address - Phone:626-575-4584
Practice Address - Fax:626-575-0882
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A632410Medicaid
CA00A632410Medicaid
CAA63241Medicare Oscar/Certification