Provider Demographics
NPI:1275551822
Name:JARAHZADEH, MICHAEL REZA (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:REZA
Last Name:JARAHZADEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5691
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:11165 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1113
Practice Address - Country:US
Practice Address - Phone:818-837-2753
Practice Address - Fax:818-898-9282
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA66127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A661270Medicaid
CAH99841Medicare UPIN
CA00A661270Medicaid