Provider Demographics
NPI:1104021104
Name:HAMID RAHMAN MD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HAMID RAHMAN MD MEDICAL CORPORATION
Other - Org Name:ORTHOPEDIC SPINE & SPORTS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:U
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-931-3800
Mailing Address - Street 1:330 E 7TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6740
Mailing Address - Country:US
Mailing Address - Phone:909-931-3800
Mailing Address - Fax:909-931-3815
Practice Address - Street 1:330 E 7TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6740
Practice Address - Country:US
Practice Address - Phone:909-931-3800
Practice Address - Fax:909-931-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36842OtherMEDICAL LICENSE
CAAR1119595OtherDEA