Provider Demographics
NPI:1295391712
Name:BAGHERPOUR INC
Entity Type:Organization
Organization Name:BAGHERPOUR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHERPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-878-6666
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty