Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT1251 | CA |
NPI | 1033130679 |
---|---|
Provider Name | Mr. Ross Rezaei |
First Address | Irvine, CA 92618-3194 |
Second Address | Irvine, CA 92618-3186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 13/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3791439 | (05) | CA |
OT0012510 | BLUE SHIELD OF CALIFORNIA (01) | CA |