Provider Demographics
NPI:1558371237
Name:REZA GOVASHIRI,M.D.INC
Entity Type:Organization
Organization Name:REZA GOVASHIRI,M.D.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVASHIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-830-4201
Mailing Address - Street 1:24421 CALLE DE LA LOUISA STE 200
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7609
Mailing Address - Country:US
Mailing Address - Phone:949-830-4201
Mailing Address - Fax:949-838-4223
Practice Address - Street 1:24421 CALLE DE LA LOUISA STE 200
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7609
Practice Address - Country:US
Practice Address - Phone:949-830-4201
Practice Address - Fax:949-838-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50068AMedicare ID - Type Unspecified
CAF51487Medicare UPIN