Provider Demographics
NPI:1710287032
Name:NAGHIBI, MOHAMMAD R (PA-C)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:R
Last Name:NAGHIBI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1170
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5213
Mailing Address - Country:US
Mailing Address - Phone:310-642-7774
Mailing Address - Fax:
Practice Address - Street 1:9601 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1170
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5213
Practice Address - Country:US
Practice Address - Phone:310-642-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21295363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA21295OtherPHYSICIAN ASSISTANT COMMITTEE, MEDICAL BOARD OF CALIFORNIA