Basic Information
| Provider Information | |||||||||
| NPI: | 1578793808 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REZA | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | SHAHED | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 W RANCH VIEW DR | ||||||||
| Address2: | SUITE #3000 | ||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957655396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164091400 | ||||||||
| FaxNumber: | 9164091499 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 W RANCH VIEW DR | ||||||||
| Address2: | SUITE #3000 | ||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957655396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164091400 | ||||||||
| FaxNumber: | 9164091499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2009 | ||||||||
| LastUpdateDate: | 07/25/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | A117572 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.