Provider Demographics
NPI:1013143619
Name:GHAVAMI SHIREHJINI, FOROUGH SADAT (DO)
Entity type:Individual
Prefix:DR
First Name:FOROUGH
Middle Name:SADAT
Last Name:GHAVAMI SHIREHJINI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TAIGA
Mailing Address - Street 2:
Mailing Address - City:COTO DE CAZA
Mailing Address - State:CA
Mailing Address - Zip Code:92679-5206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:734-213-3931
Practice Address - Street 1:8 TAIGA
Practice Address - Street 2:
Practice Address - City:COTO DE CAZA
Practice Address - State:CA
Practice Address - Zip Code:92679-5206
Practice Address - Country:US
Practice Address - Phone:888-464-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A127372084N0400X, 2084N0400X
NMA-2202-182084N0400X
AZR1690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA-2202-18OtherNEW MEXICO MEDICAL LICENSE