Provider Demographics
NPI:1295822286
Name:SADIGHIAN, MANOOCHEHR (MD)
Entity Type:Individual
Prefix:MR
First Name:MANOOCHEHR
Middle Name:
Last Name:SADIGHIAN
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 1:7237 E SOUTHGATE DR
Mailing Address - Street 2:SUITE # A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2637
Mailing Address - Country:US
Mailing Address - Phone:916-424-4447
Mailing Address - Fax:916-424-7958
Practice Address - Street 1:7237 E SOUTHGATE DR
Practice Address - Street 2:SUITE # A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2637
Practice Address - Country:US
Practice Address - Phone:916-424-4447
Practice Address - Fax:916-424-7958
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38659208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A386590Medicaid
CAA28683Medicare UPIN
CAYYY50006YMedicare ID - Type Unspecified
CA00A386590Medicaid