Provider Demographics
NPI:1336313378
Name:REZA NAZEMI, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:REZA NAZEMI, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-341-3400
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:K308
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-341-3400
Mailing Address - Fax:760-340-5050
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:K308
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-341-3400
Practice Address - Fax:760-340-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA341802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A341800Medicaid
CA00A341800Medicaid