MEDICARE: DR. REZA PEYMANI MD, MPH

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1679979884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REZA PEYMANI MD, MPH

Provider Business Mailing Address
First Line	:	4615 CENTER BLVD APT 3005
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5770
Country	:	US
Telephone Number	:	310-498-7474
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 S BEVERLY GLEN BLVD APT 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5138
Country	:	US
Telephone Number	:	310-498-7474
Fax Number	:

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

Provider Enumeration Date	:	11/15/2014
Last Update Date	:	05/19/2022

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