Provider Demographics
NPI:1669631016
Name:MOVAFAGH-TOFIGH, SHARAREH (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SHARAREH
Middle Name:
Last Name:MOVAFAGH-TOFIGH
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:SHARAREH
Other - Middle Name:
Other - Last Name:MOVAFAGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:12712 HEACOCK ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3037
Mailing Address - Country:US
Mailing Address - Phone:951-485-0335
Mailing Address - Fax:
Practice Address - Street 1:12712 HEACOCK ST STE 1
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3037
Practice Address - Country:US
Practice Address - Phone:951-485-0335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0073119207R00000X
CAA109434207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine