Provider Demographics
NPI:1093078263
Name:EMAMI, MUHAMMAD REZA (MS)
Entity Type:Individual
Prefix:MR
First Name:MUHAMMAD
Middle Name:REZA
Last Name:EMAMI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42055 50TH ST W
Mailing Address - Street 2:SUITE 7
Mailing Address - City:QUARTZ HILL
Mailing Address - State:CA
Mailing Address - Zip Code:93536-3520
Mailing Address - Country:US
Mailing Address - Phone:310-567-9389
Mailing Address - Fax:
Practice Address - Street 1:2432 CAROLYN DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-5444
Practice Address - Country:US
Practice Address - Phone:310-567-9389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51561106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist