Provider Demographics
NPI:1376858852
Name:H F ESHRAGHI MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:H F ESHRAGHI MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ESHRAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-500-7070
Mailing Address - Street 1:PO BOX 993
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91209-0993
Mailing Address - Country:US
Mailing Address - Phone:818-500-7070
Mailing Address - Fax:818-500-4902
Practice Address - Street 1:540 N CENTRAL AVE
Practice Address - Street 2:STE 110
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1916
Practice Address - Country:US
Practice Address - Phone:818-500-7070
Practice Address - Fax:818-500-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41308207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE71901Medicare UPIN