Provider Demographics
NPI:1457823254
Name:FATHI, NAGHMEH
Entity Type:Individual
Prefix:
First Name:NAGHMEH
Middle Name:
Last Name:FATHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16012 LEGACY RD UNIT 314
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-2822
Mailing Address - Country:US
Mailing Address - Phone:949-295-3737
Mailing Address - Fax:
Practice Address - Street 1:16012 LEGACY RD UNIT 314
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-2822
Practice Address - Country:US
Practice Address - Phone:949-295-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant