Basic Information
| Provider Information | |||||||||
| NPI: | 1881119501 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOHAMMADI | ||||||||
| FirstName: | ORANUS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 609 ANDERSON RD | ||||||||
| Address2: | |||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956163548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 15307608966 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20900 BISCAYNE BLVD | ||||||||
| Address2: | |||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331801407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056827000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2017 | ||||||||
| LastUpdateDate: | 08/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 91722873F15357 | 05 | CA | MEDICAID |