Provider Demographics
NPI:1295001493
Name:BAGHERPOUR, REZA (MD)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:BAGHERPOUR
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 1:70077 RAMON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5201
Mailing Address - Country:US
Mailing Address - Phone:760-895-6557
Mailing Address - Fax:760-895-6601
Practice Address - Street 1:70077 RAMON RD STE 1
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5201
Practice Address - Country:US
Practice Address - Phone:760-895-6557
Practice Address - Fax:760-895-6601
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA156323208100000X
VA0101263437208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA156323OtherMEDICAL LICENSE