Provider Demographics
NPI:1164566717
Name:REZA AHMADINIA, M.D., INC
Entity Type:Organization
Organization Name:REZA AHMADINIA, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:AHMADINIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-946-2243
Mailing Address - Street 1:18112 OUTER HIGHWAY 18
Mailing Address - Street 2:SUITE 101
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2211
Mailing Address - Country:US
Mailing Address - Phone:760-946-2243
Mailing Address - Fax:866-734-9830
Practice Address - Street 1:18112 OUTER HIGHWAY 18
Practice Address - Street 2:SUITE 101
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2211
Practice Address - Country:US
Practice Address - Phone:760-946-2243
Practice Address - Fax:866-734-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty