Provider Demographics
NPI:1700377371
Name:MAGHSOODI-DEERWESTER, MONA (MD, MSC)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:MAGHSOODI-DEERWESTER
Suffix:
Gender:F
Credentials:MD, MSC
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:DEERWESTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:101 E REDLANDS BLVD STE 284
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4721
Mailing Address - Country:US
Mailing Address - Phone:909-707-5979
Mailing Address - Fax:
Practice Address - Street 1:101 E REDLANDS BLVD STE 284
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4721
Practice Address - Country:US
Practice Address - Phone:909-707-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-19
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA186745207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology