Provider Demographics
NPI:1477997336
Name:EMDADI, ARAS (DO)
Entity Type:Individual
Prefix:
First Name:ARAS
Middle Name:
Last Name:EMDADI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 INDIANA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-4557
Mailing Address - Country:US
Mailing Address - Phone:951-276-9012
Mailing Address - Fax:951-276-9163
Practice Address - Street 1:7111 INDIANA AVE STE 100
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-4557
Practice Address - Country:US
Practice Address - Phone:951-276-9012
Practice Address - Fax:951-276-9163
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17463208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty