Provider Demographics
NPI:1407199896
Name:TAGHADOSI, FARNOOSH (MD)
Entity Type:Individual
Prefix:
First Name:FARNOOSH
Middle Name:
Last Name:TAGHADOSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 S BEVERLY DR
Mailing Address - Street 2:#3104
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4813
Mailing Address - Country:US
Mailing Address - Phone:310-786-7204
Mailing Address - Fax:310-734-7268
Practice Address - Street 1:312 S BEVERLY DR
Practice Address - Street 2:#3104
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4813
Practice Address - Country:US
Practice Address - Phone:310-786-7204
Practice Address - Fax:310-734-7268
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143593207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine