Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A14895 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 20A14895 | CA |
NPI | 1013399195 |
---|---|
Provider Name | Dr. Mohammed Taghi Rezai |
First Address | Thousand Oaks, CA 91360-5800 |
Second Address | Thousand Oaks, CA 91360-5800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2015 |
Last Update Date | 03/12/2021 |