Provider Demographics
NPI:1710291570
Name:HAGHDOOST, MOHAMMAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:HAGHDOOST
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 NORMAN DR
Mailing Address - Street 2:SUITE 203B
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5925
Mailing Address - Country:US
Mailing Address - Phone:650-804-4610
Mailing Address - Fax:866-589-7497
Practice Address - Street 1:1144 NORMAN DR STE 204
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5960
Practice Address - Country:US
Practice Address - Phone:209-665-4252
Practice Address - Fax:866-589-7497
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111081208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery