Provider Demographics
NPI:1912044173
Name:NASSEHZADEH TABRIZ, ABDOLREZA (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDOLREZA
Middle Name:
Last Name:NASSEHZADEH TABRIZ
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 1:7621 SHADY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-3702
Mailing Address - Country:US
Mailing Address - Phone:707-628-4150
Mailing Address - Fax:
Practice Address - Street 1:889 CASTRO ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-2014
Practice Address - Country:US
Practice Address - Phone:650-967-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA729230Medicaid
CAH11356Medicare UPIN
CA00A729231Medicare ID - Type Unspecified