Provider Demographics
NPI:1356608608
Name:SAGHEBRAI, MAHZAD
Entity type:Individual
Prefix:
First Name:MAHZAD
Middle Name:
Last Name:SAGHEBRAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15007 BURBANK BLVD APT 205
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-3649
Mailing Address - Country:US
Mailing Address - Phone:310-963-8858
Mailing Address - Fax:
Practice Address - Street 1:1120 N TOWN CENTER DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6302
Practice Address - Country:US
Practice Address - Phone:866-960-7691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-0561225200000X
CAPTA8651225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant