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NPI Code Detail

MEDICARE: NINA REZAI MD

MEDICARE:   NINA  REZAI  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianA63177CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1004631770OTHERCABLUE SHIELD

General Provider Information

NPI Number : 1063408490
Entity Type Code : Individual
Provider Name (Legal Business Name) : NINA REZAI MD
Provider Business Mailing Address
First Line : 2350 W EL CAMINO REAL
Second Line : 2ND FLOOR
City : MOUNTAIN VIEW
State : CA
Zip : 94040-6201
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7225 RAINBOW DR
Second Line :
City : SAN JOSE
State : CA
Zip : 95129-4552
Country : US
Telephone Number : 408-524-5750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 09/17/2012

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Directions to “ NINA REZAI MD” Practice Location

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