Provider Demographics
NPI:1235243429
Name:AHMADINIA, MOHAMMAD REZA (MD)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:REZA
Last Name:AHMADINIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A852040Medicaid
CAI13340Medicare UPIN
CA00A852040Medicaid