Provider Demographics
NPI:1912322728
Name:SHAHRZAD SHAREGHI MD PC
Entity Type:Organization
Organization Name:SHAHRZAD SHAREGHI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAREGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-245-5415
Mailing Address - Street 1:2220 LYNN RD STE 208
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-8042
Mailing Address - Country:US
Mailing Address - Phone:646-245-5415
Mailing Address - Fax:
Practice Address - Street 1:235 N CONEJO SCHOOL RD APT 110
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2675
Practice Address - Country:US
Practice Address - Phone:646-245-5415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty