Provider Demographics
NPI:1275567927
Name:SADEGHI, PARRISH (MD)
Entity Type:Individual
Prefix:
First Name:PARRISH
Middle Name:
Last Name:SADEGHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 17TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5542
Mailing Address - Country:US
Mailing Address - Phone:310-560-2101
Mailing Address - Fax:310-954-9502
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 480W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2121
Practice Address - Country:US
Practice Address - Phone:310-954-9501
Practice Address - Fax:310-954-9502
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44336207N00000X
CAA86498207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A864980OtherMEDICAL PPIN #
CAWA86498BMedicare ID - Type UnspecifiedPPIN #
CAI23575Medicare UPIN
COC807090Medicare PIN