Provider Demographics
NPI:1881687309
Name:RAHIMI, MOSTAFA S (MD)
Entity Type:Individual
Prefix:MR
First Name:MOSTAFA
Middle Name:S
Last Name:RAHIMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOSTAFA
Other - Middle Name:S
Other - Last Name:RAHIMI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:10 WOODLAND RD
Practice Address - Street 2:ICU ROOM 500
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9554
Practice Address - Country:US
Practice Address - Phone:707-963-6445
Practice Address - Fax:707-967-5656
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 89780207QG0300X
CAA89780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI 29362Medicare UPIN
CACA211655Medicare PIN