Provider Demographics
NPI:1992842918
Name:ABBAS MAHDAVI MD
Entity Type:Organization
Organization Name:ABBAS MAHDAVI MD
Other - Org Name:DELTA PEDIATRICS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHDAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-754-7200
Mailing Address - Street 1:3903 LONE TREE WAY
Mailing Address - Street 2:211
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509
Mailing Address - Country:US
Mailing Address - Phone:925-754-7200
Mailing Address - Fax:925-754-7290
Practice Address - Street 1:3903 LONE TREE WAY
Practice Address - Street 2:211
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509
Practice Address - Country:US
Practice Address - Phone:925-754-7200
Practice Address - Fax:925-754-7290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA313250208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6202716OtherMCAL