Provider Demographics
NPI:1942832399
Name:MOGHANI, DARYOUSH (RCLD)
Entity Type:Individual
Prefix:
First Name:DARYOUSH
Middle Name:
Last Name:MOGHANI
Suffix:
Gender:M
Credentials:RCLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11605 N LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-2658
Mailing Address - Country:US
Mailing Address - Phone:737-222-6996
Mailing Address - Fax:512-522-8836
Practice Address - Street 1:1820 W VERDUGO AVE # 9692
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2150
Practice Address - Country:US
Practice Address - Phone:747-261-7447
Practice Address - Fax:512-522-8836
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1927156FC0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens