Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | A70810 | CA |
Y | 207RP1001X | Pulmonary Disease | A70810 | CA |
NPI | 1083677405 |
---|---|
Provider Name | Dr. Hossein Razavi |
First Address | Saint Helena, CA 94574-9501 |
Second Address | Saint Helena, CA 94574-9501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 30/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A708100 | (05) | CA |
ZZZ02470Z | GROUP MEDICARE PTAN (01) |