Provider Demographics
NPI:1588968697
Name:DR. DEBORA SEDAGHAT OBGYN, INC.
Entity type:Organization
Organization Name:DR. DEBORA SEDAGHAT OBGYN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OBGYN PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:SANAM
Authorized Official - Last Name:SEDAGHAT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-490-2126
Mailing Address - Street 1:11100 WARNER AVE
Mailing Address - Street 2:106
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7506
Mailing Address - Country:US
Mailing Address - Phone:714-966-2112
Mailing Address - Fax:714-966-2335
Practice Address - Street 1:11100 WARNER AVE
Practice Address - Street 2:106
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7506
Practice Address - Country:US
Practice Address - Phone:714-966-2112
Practice Address - Fax:714-966-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578619243OtherINDIVIDUAL