Healthcare Provider Details

I. General information

NPI: 1679111710
Provider Name (Legal Business Name): REZA KALHOR NMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 E BROADWAY RD
TEMPE AZ
85282-1751
US

IV. Provider business mailing address

2325 E RIO SALADO PKWY APT 3001
TEMPE AZ
85288-7480
US

V. Phone/Fax

Practice location:
  • Phone: 480-858-9100
  • Fax:
Mailing address:
  • Phone: 949-444-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1534
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number25-1912
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: