Provider Demographics
NPI:1952959710
Name:MOHTASHEMI, PEGAH
Entity type:Individual
Prefix:
First Name:PEGAH
Middle Name:
Last Name:MOHTASHEMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PEGAH
Other - Middle Name:
Other - Last Name:NEJAD MOHTASHEMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 CARDIFF
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2936
Mailing Address - Country:US
Mailing Address - Phone:949-874-4949
Mailing Address - Fax:
Practice Address - Street 1:9 CARDIFF
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2936
Practice Address - Country:US
Practice Address - Phone:949-874-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program