Provider Demographics
NPI:1326329012
Name:TADAYON-NEJAD, REZA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:TADAYON-NEJAD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8835 VANS ST
Mailing Address - Street 2:LA PAZ GEROPSYCHIATRIC CENTER
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-4656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8835 VANS ST
Practice Address - Street 2:LA PAZ GEROPSYCHIATRIC CENTER
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-4656
Practice Address - Country:US
Practice Address - Phone:562-633-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1375732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400244155Medicare Oscar/Certification