Provider Demographics
NPI:1952794455
Name:AZGHADI, SOHEILA
Entity Type:Individual
Prefix:
First Name:SOHEILA
Middle Name:
Last Name:AZGHADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOHEILA
Other - Middle Name:
Other - Last Name:FAYEGHI NEJAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:575 LENNON LN
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2443
Practice Address - Country:US
Practice Address - Phone:925-433-8786
Practice Address - Fax:925-433-8788
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1574102085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program