Provider Demographics
NPI:1134439367
Name:SHADIAN HAGHIGHI, MOHAMMAD ALI (PA-C)
Entity type:Individual
Prefix:
First Name:MOHAMMAD ALI
Middle Name:
Last Name:SHADIAN HAGHIGHI
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 1:4823 N WINDWARD WAY
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-4671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7565 N CEDAR AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2687
Practice Address - Country:US
Practice Address - Phone:559-438-8888
Practice Address - Fax:559-438-8887
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPAC 21139363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical