Provider Demographics
NPI:1417368804
Name:AGHAMOHAMMADI, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:AGHAMOHAMMADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:AGHAMOHAMADI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10535 WILSHIRE BLVD APT D09
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4514
Mailing Address - Country:US
Mailing Address - Phone:310-903-8652
Mailing Address - Fax:323-361-1001
Practice Address - Street 1:4650 W SUNSET BLVD # MS 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-5918
Practice Address - Fax:323-361-1001
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1124752080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine