Basic Information
| Provider Information | |||||||||
| NPI: | 1902244056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASOOMI | ||||||||
| FirstName: | REZA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1331 N 7TH ST | ||||||||
| Address2: | STE 375 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023070070 | ||||||||
| FaxNumber: | 6023070080 | ||||||||
| Practice Location | |||||||||
| Address1: | 1331 N 7TH ST STE 375 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023070700 | ||||||||
| FaxNumber: | 6023070080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2013 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9408126 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 9408126 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 62005 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.