Provider Demographics
NPI:1295240976
Name:MOHRDAR-GHAEMMAGHAMI, ROXANA (ND)
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:MOHRDAR-GHAEMMAGHAMI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6086 BROCKTON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2203
Mailing Address - Country:US
Mailing Address - Phone:951-781-4529
Mailing Address - Fax:951-781-8198
Practice Address - Street 1:6086 BROCKTON AVE STE 4
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2203
Practice Address - Country:US
Practice Address - Phone:951-781-4529
Practice Address - Fax:951-781-8198
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND945175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAND945OtherNATUROPATHIC MEDICINE COMMITTEE