Healthcare Provider Details

I. General information

NPI: 1265177646
Provider Name (Legal Business Name): REZA ALAGHEHBANDAN MD, MSC, FRCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2022
Last Update Date: 05/01/2022
Certification Date: 05/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E COLUMBIA ST
NEW WESTMINSTER BRITISH COLUMBIA
V3E0G9
CA

IV. Provider business mailing address

52-1295 SOBALL ST
COQUITLAM CA
V3E0G9
CA

V. Phone/Fax

Practice location:
  • Phone: 604-520-4747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number35.144518
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: