Provider Demographics
NPI:1043218563
Name:NAHED, MOHAMMAD REZA (MD FCCP)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:REZA
Last Name:NAHED
Suffix:
Gender:M
Credentials:MD FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 262265
Mailing Address - Street 2:301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92196-2265
Mailing Address - Country:US
Mailing Address - Phone:818-639-4333
Mailing Address - Fax:818-639-4332
Practice Address - Street 1:11550 INDIAN HILLS RD
Practice Address - Street 2:301
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345
Practice Address - Country:US
Practice Address - Phone:818-365-4585
Practice Address - Fax:818-365-5265
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2016-05-19
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2008-01-28
Provider Licenses
StateLicense IDTaxonomies
CAA33769207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50233Medicare UPINUPIN