Provider Demographics
NPI:1558576496
Name:HAGHIGHAT, PEYMAN (MD)
Entity Type:Individual
Prefix:
First Name:PEYMAN
Middle Name:
Last Name:HAGHIGHAT
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 1:1595 SOQUEL DR
Mailing Address - Street 2:STE 350
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065
Mailing Address - Country:US
Mailing Address - Phone:831-427-7110
Mailing Address - Fax:831-427-7108
Practice Address - Street 1:1595 SOQUEL DR
Practice Address - Street 2:STE 350
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065
Practice Address - Country:US
Practice Address - Phone:831-427-7110
Practice Address - Fax:831-427-7108
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104590207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA104590OtherMEDICAL LICENSE
CABO872WOtherMEDICARE PTAN