Provider Demographics
NPI:1154582641
Name:ESHAGHIAN, ALEX (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:ESHAGHIAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:845
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-8025
Mailing Address - Country:US
Mailing Address - Phone:818-835-1833
Mailing Address - Fax:
Practice Address - Street 1:16311 VENTURA BLVD STE 845
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4330
Practice Address - Country:US
Practice Address - Phone:818-835-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110726207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology