MEDICARE: MEHDI MODARAEI

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
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1104066000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEHDI MODARAEI

Provider Business Mailing Address
First Line	:	385 S OAKLAND AVE APT 303
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-3324
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	385 S OAKLAND AVE APT 303
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-3324
Country	:	US
Telephone Number	:	909-520-2432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	03/05/2009

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Directions to “ MEHDI MODARAEI ” Practice Location

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