Provider Demographics
NPI:1689049538
Name:VEDAD HAGHI, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:VEDAD HAGHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:VEDAD HAGHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3332 BROOKE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3774
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39815 ALTA MURRIETA DR STE C1
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5405
Practice Address - Country:US
Practice Address - Phone:951-304-7673
Practice Address - Fax:951-304-7680
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist