Provider Demographics
NPI:1912139528
Name:ROHANINEJAD, MOHAMMADREZA (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMADREZA
Middle Name:
Last Name:ROHANINEJAD
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 1:14981 NATIONAL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2600
Mailing Address - Country:US
Mailing Address - Phone:408-358-3111
Mailing Address - Fax:408-358-3114
Practice Address - Street 1:14981 NATIONAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2600
Practice Address - Country:US
Practice Address - Phone:408-358-3111
Practice Address - Fax:408-358-3114
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108612208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery