Provider Demographics
NPI:1164914487
Name:REZAMAND, MAHIN (RDA)
Entity Type:Individual
Prefix:MRS
First Name:MAHIN
Middle Name:
Last Name:REZAMAND
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 WHITE ASH RD
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-9008
Mailing Address - Country:US
Mailing Address - Phone:626-485-7714
Mailing Address - Fax:909-571-5850
Practice Address - Street 1:1451 N MONTEBELLO BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2584
Practice Address - Country:US
Practice Address - Phone:323-724-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF780A52374OtherANTHEM BLUE CROSS