1578793808 NPI number — MOHAMMAD SHAHED REZA MD

Table of content: MOHAMMAD SHAHED REZA MD (NPI 1578793808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578793808 NPI number — MOHAMMAD SHAHED REZA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REZA
Provider First Name:
MOHAMMAD
Provider Middle Name:
SHAHED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1578793808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 W RANCH VIEW DR
Provider Second Line Business Mailing Address:
SUITE #3000
Provider Business Mailing Address City Name:
ROCKLIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95765-5396
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-409-1400
Provider Business Mailing Address Fax Number:
916-409-1499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 W RANCH VIEW DR
Provider Second Line Business Practice Location Address:
SUITE #3000
Provider Business Practice Location Address City Name:
ROCKLIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95765-5396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-409-1400
Provider Business Practice Location Address Fax Number:
916-409-1499
Provider Enumeration Date:
07/21/2009

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: A117572 , 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)