Provider Demographics
NPI:1144539644
Name:MOSHFEGH, AMIEL (MD)
Entity type:Individual
Prefix:DR
First Name:AMIEL
Middle Name:
Last Name:MOSHFEGH
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 1:110 NEW STINE RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2605
Mailing Address - Country:US
Mailing Address - Phone:323-347-1002
Mailing Address - Fax:323-433-9177
Practice Address - Street 1:2250 S ATLANTIC BLVD STE G
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-3949
Practice Address - Country:US
Practice Address - Phone:323-347-1002
Practice Address - Fax:323-433-9177
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 1099042085R0202X
CAA1099042085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology