Provider Demographics
NPI:1619109378
Name:ESHRAGHI, RAUZ ANGELIC (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUZ
Middle Name:ANGELIC
Last Name:ESHRAGHI
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 1:1250 LA VENTA DR
Mailing Address - Street 2:STE 202
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3702
Mailing Address - Country:US
Mailing Address - Phone:805-496-5153
Mailing Address - Fax:805-496-5202
Practice Address - Street 1:1250 LA VENTA DR
Practice Address - Street 2:STE. 202
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3702
Practice Address - Country:US
Practice Address - Phone:805-496-5153
Practice Address - Fax:805-496-5202
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619109879Medicaid
CA1619109378OtherCCS PANELED
CA1619109378OtherCCS PANELED