Provider Demographics
NPI:1780632067
Name:YAGHMAI, REZA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:YAGHMAI
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 1:1840 WEST DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6115
Mailing Address - Country:US
Mailing Address - Phone:760-643-2000
Mailing Address - Fax:760-945-6011
Practice Address - Street 1:1840 WEST DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6115
Practice Address - Country:US
Practice Address - Phone:760-643-2000
Practice Address - Fax:760-945-6011
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA060683207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine