1396124293 NPI number — FOAD ELAHI MD CALIFORNIA CENTER OF PAIN MEDICINE AND REHABILITATION I

Table of content: (NPI 1396124293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396124293 NPI number — FOAD ELAHI MD CALIFORNIA CENTER OF PAIN MEDICINE AND REHABILITATION I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOAD ELAHI MD CALIFORNIA CENTER OF PAIN MEDICINE AND REHABILITATION I
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
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NPI Number Information

NPI Number:
1396124293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1144 NORMAN DR
Provider Second Line Business Mailing Address:
104
Provider Business Mailing Address City Name:
MANTECA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95336-5925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-824-4400
Provider Business Mailing Address Fax Number:
209-824-4420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1144 NORMAN DR
Provider Second Line Business Practice Location Address:
104
Provider Business Practice Location Address City Name:
MANTECA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95336-5925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-824-4400
Provider Business Practice Location Address Fax Number:
209-824-4420
Provider Enumeration Date:
05/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ELAHI
Authorized Official First Name:
FOAD
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER
Authorized Official Telephone Number:
312-863-9377

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  A106279 , 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)





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