Basic Information
| Provider Information | |||||||||
| NPI: | 1386381754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAHRAMI | ||||||||
| FirstName: | AHMAD | ||||||||
| MiddleName: | FARID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6171 BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945604005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105989772 | ||||||||
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| Practice Location | |||||||||
| Address1: | 28062 BAXTER RD | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925631401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512904000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2022 | ||||||||
| LastUpdateDate: | 05/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | RESIDENT | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.