Provider Demographics
NPI:1770570988
Name:TOFIGHRAD, MEHRAN (DPM)
Entity type:Individual
Prefix:
First Name:MEHRAN
Middle Name:
Last Name:TOFIGHRAD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12340 SANTA MONICA BLVD
Mailing Address - Street 2:221
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2500
Mailing Address - Country:US
Mailing Address - Phone:310-447-0700
Mailing Address - Fax:310-447-0701
Practice Address - Street 1:12340 SANTA MONICA BLVD
Practice Address - Street 2:221
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2594
Practice Address - Country:US
Practice Address - Phone:310-447-0700
Practice Address - Fax:310-447-0701
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4020213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40201Medicaid
CA000E40202Medicaid
CAU65767Medicare UPIN
CA000E40201Medicaid
CAE4020Medicare ID - Type Unspecified
CAE4020AMedicare ID - Type Unspecified