Provider Demographics
NPI:1891728788
Name:RASHIDI-NAIMABADI, MAHMOUD (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:RASHIDI-NAIMABADI
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 1:95 MONTGOMERY DR
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6617
Mailing Address - Country:US
Mailing Address - Phone:707-545-7175
Mailing Address - Fax:707-545-7938
Practice Address - Street 1:95 MONTGOMERY DR
Practice Address - Street 2:SUITE 118
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6617
Practice Address - Country:US
Practice Address - Phone:707-545-7175
Practice Address - Fax:707-545-7938
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87654207T00000X
NH14974207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH71101Medicare UPIN
NH001714401Medicare PIN