Provider Demographics
NPI:1699722397
Name:PASHMFOROUSH, MOHAMMAD (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:PASHMFOROUSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHAMMAD
Other - Middle Name:
Other - Last Name:PASHMFOROUSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2424 VISTA WAY, SUITE 300-301
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054
Mailing Address - Country:US
Mailing Address - Phone:760-630-1606
Mailing Address - Fax:760-630-1654
Practice Address - Street 1:2424 VISTA WAY, SUITE 300-301
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054
Practice Address - Country:US
Practice Address - Phone:760-630-1606
Practice Address - Fax:760-630-1654
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60730207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100430OtherGROUP MEDICAL
CAW18762OtherGROUP MEDICARE
CAA60730OtherSTATE LICENSE
CA1902846306OtherGROUP NPI