Provider Demographics
NPI:1235642810
Name:REDAN MEDICAL
Entity Type:Organization
Organization Name:REDAN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRI
Authorized Official - Suffix:
Authorized Official - Credentials:EMBA
Authorized Official - Phone:720-755-5555
Mailing Address - Street 1:2030 MAIN ST STE 1300
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7220
Mailing Address - Country:US
Mailing Address - Phone:949-260-9119
Mailing Address - Fax:949-260-4799
Practice Address - Street 1:2030 MAIN ST STE 1300
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-7220
Practice Address - Country:US
Practice Address - Phone:949-260-9119
Practice Address - Fax:949-260-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304700218253Z00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care