1063582112 NPI number — DR. CAMIAR OHADI M.D

Table of content: DR. CAMIAR OHADI M.D (NPI 1063582112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063582112 NPI number — DR. CAMIAR OHADI M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OHADI
Provider First Name:
CAMIAR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063582112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11088 ELM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-7676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-625-2000
Provider Business Mailing Address Fax Number:
909-625-2099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9655 MONTEVISTA AVE STE 403
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-625-2000
Provider Business Practice Location Address Fax Number:
909-625-2099
Provider Enumeration Date:
11/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  G79807 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2832233 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G79807 . This is a "LIC NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".