Provider Demographics
NPI:1609857788
Name:RAZAVI, MEHRDAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:RAZAVI
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 1:1505 VICTOR AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-4031
Mailing Address - Country:US
Mailing Address - Phone:530-242-9273
Mailing Address - Fax:530-242-5873
Practice Address - Street 1:1505 VICTOR AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4031
Practice Address - Country:US
Practice Address - Phone:530-242-9273
Practice Address - Fax:530-242-5873
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD601010492084S0012X, 2084S0012X
CAC530332084S0012X, 2084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1186148Medicaid
IAG90239Medicare UPIN