Provider Demographics
NPI:1427153550
Name:MOGHADDAM, EILYA (MD)
Entity type:Individual
Prefix:DR
First Name:EILYA
Middle Name:
Last Name:MOGHADDAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 APPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5653
Mailing Address - Country:US
Mailing Address - Phone:916-878-2588
Mailing Address - Fax:916-878-2622
Practice Address - Street 1:1 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3037
Practice Address - Country:US
Practice Address - Phone:916-781-1927
Practice Address - Fax:916-781-1757
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA759225207R00000X
CAA85645208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A856450Medicaid
H82399Medicare UPIN
CA00A856450Medicaid