Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | A33769 | CA |
NPI | 1043218563 |
---|---|
Provider Name | Mohammad Reza Nahed |
First Address | San Diego, CA 92196-2265 |
Second Address | Mission Hills, CA 91345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 19/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B50233 | UPIN (02) | CA |