Provider Demographics
NPI:1861489700
Name:NEIL, REZA (MD)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:NEIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:REZA
Other - Middle Name:
Other - Last Name:NILFOROOSHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7872 EIGLEBERRY STREET
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020
Mailing Address - Country:US
Mailing Address - Phone:408-848-3365
Mailing Address - Fax:408-848-1580
Practice Address - Street 1:7872 EIGLEBERRY STREET
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020
Practice Address - Country:US
Practice Address - Phone:408-848-3365
Practice Address - Fax:408-848-1580
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40399208600000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407910OtherCIGNA
CA1901117Medicaid
CA1901117Medicaid
CAC03997Medicare UPIN