Provider Demographics
NPI:1912099417
Name:TOUSSI, REZA MATT (MD)
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:MATT
Last Name:TOUSSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMMADREZA
Other - Middle Name:
Other - Last Name:MONSHIZADEH TOUSSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7115 GREENBACK LN
Practice Address - Street 2:FL 3
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-6133
Practice Address - Country:US
Practice Address - Phone:916-536-3540
Practice Address - Fax:916-536-2455
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000810585897OtherPHCS
CA00A797820Medicaid
CA7357301OtherAETNA
CA1750512OtherGREAT WEST
CA2063190OtherFIRST HEALTH
CA095705OtherHEALTH NET
CA8010881OtherCIGNA
CA2688229OtherUNITED HEALTHCARE
CAA79782OtherBLUE CROSS
CA86784OtherINTERPLAN
CA90130254OtherPACIFICARE
CAMCMG253700OtherWESTERN HEALTH ADVANTAGE
CA00A797820Medicaid
CA000810585897OtherPHCS