Provider Demographics
NPI:1487306395
Name:BAGHERI, FATEMEH
Entity type:Individual
Prefix:
First Name:FATEMEH
Middle Name:
Last Name:BAGHERI
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 1:22246 VICTORY BLVD APT F219
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1813
Mailing Address - Country:US
Mailing Address - Phone:310-488-5680
Mailing Address - Fax:
Practice Address - Street 1:20011 VENTURA BLVD # 1002
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2573
Practice Address - Country:US
Practice Address - Phone:310-488-5680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1968532471S1302X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography