Healthcare Provider Details

I. General information

NPI: 1780858852
Provider Name (Legal Business Name): MOHAMMAD REZA HOJJATI M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 S VAL VISTA DR STE 187
GILBERT AZ
85295-1674
US

IV. Provider business mailing address

PO BOX 756
CHANDLER AZ
85244-0756
US

V. Phone/Fax

Practice location:
  • Phone: 480-476-8750
  • Fax: 480-476-8749
Mailing address:
  • Phone: 480-476-8750
  • Fax: 480-476-8749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number46481
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: