Provider Demographics
NPI:1184634826
Name:ABDOLLAHZADEH, HOMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOMAN
Middle Name:
Last Name:ABDOLLAHZADEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HOMAN
Other - Middle Name:A
Other - Last Name:ZADEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1330 N INDIAN CANYON DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4880
Mailing Address - Country:US
Mailing Address - Phone:760-864-4163
Mailing Address - Fax:760-864-4166
Practice Address - Street 1:1330 N INDIAN CANYON DR
Practice Address - Street 2:SUITE F
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4880
Practice Address - Country:US
Practice Address - Phone:760-864-4163
Practice Address - Fax:760-864-4166
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60802207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A608020Medicaid
00A608020Medicare ID - Type Unspecified
CA00A608020Medicaid