Provider Demographics
NPI:1467493163
Name:BAGHERI, BITA (MD)
Entity type:Individual
Prefix:DR
First Name:BITA
Middle Name:
Last Name:BAGHERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:520 SUPERIOR AVE STE 335
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3672
Mailing Address - Country:US
Mailing Address - Phone:949-236-7900
Mailing Address - Fax:949-236-7900
Practice Address - Street 1:520 SUPERIOR AVE STE 335
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3672
Practice Address - Country:US
Practice Address - Phone:949-236-7900
Practice Address - Fax:949-236-7900
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86148207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1730180415OtherGROUP PTAN
CAG86148OtherMEDICAL LICENSE
PAP00216382OtherRR MEDICARE