Provider Demographics
NPI:1275742041
Name:SADEGHI, HABIBOLLAH MERZAD (DO)
Entity Type:Individual
Prefix:DR
First Name:HABIBOLLAH
Middle Name:MERZAD
Last Name:SADEGHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:HABIB
Other - Middle Name:M
Other - Last Name:SADEGHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:28632 ROADSIDE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301
Mailing Address - Country:US
Mailing Address - Phone:818-452-4483
Mailing Address - Fax:818-452-4488
Practice Address - Street 1:28632 ROADSIDE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301
Practice Address - Country:US
Practice Address - Phone:818-452-4483
Practice Address - Fax:818-452-4488
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine