Provider Demographics
NPI:1720050842
Name:RAHIMY, SODABEH (MD)
Entity Type:Individual
Prefix:
First Name:SODABEH
Middle Name:
Last Name:RAHIMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5153 HOLT BLVD
Practice Address - Street 2:SUITE B1
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-4837
Practice Address - Country:US
Practice Address - Phone:909-603-9000
Practice Address - Fax:909-603-9008
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI45264Medicare UPIN