Provider Demographics
NPI:1902125776
Name:HAGHIGHI MOTLAGH, BEHNAZ (MD)
Entity Type:Individual
Prefix:
First Name:BEHNAZ
Middle Name:
Last Name:HAGHIGHI MOTLAGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27781 LA PAZ RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3919
Mailing Address - Country:US
Mailing Address - Phone:949-831-0300
Mailing Address - Fax:949-831-0339
Practice Address - Street 1:27781 LA PAZ RD
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3919
Practice Address - Country:US
Practice Address - Phone:949-831-0300
Practice Address - Fax:949-831-0339
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118279207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB220112Medicare PIN
CAGX580ZMedicare PIN