Provider Demographics
NPI:1639977937
Name:DAGHIGHI, SHAHRZAD
Entity type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:
Last Name:DAGHIGHI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LINDEN AVE APT 415
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4921
Mailing Address - Country:US
Mailing Address - Phone:310-696-1955
Mailing Address - Fax:
Practice Address - Street 1:140 LINDEN AVE APT 415
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4921
Practice Address - Country:US
Practice Address - Phone:310-696-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95320784163W00000X
CA2024101223363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse