Provider Demographics
NPI:1013605252
Name:ERIC CHAGHOURI, MD, INC.
Entity Type:Organization
Organization Name:ERIC CHAGHOURI, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAGHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-320-4882
Mailing Address - Street 1:10780 SANTA MONICA BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7613
Mailing Address - Country:US
Mailing Address - Phone:424-320-4882
Mailing Address - Fax:
Practice Address - Street 1:10780 SANTA MONICA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7613
Practice Address - Country:US
Practice Address - Phone:424-320-4882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty