Healthcare Provider Details

I. General information

NPI: 1861800633
Provider Name (Legal Business Name): ABBAS MAHDAVI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SUNSET LN STE 3
ANTIOCH CA
94509-6123
US

IV. Provider business mailing address

3700 SUNSET LN STE 3
ANTIOCH CA
94509-6123
US

V. Phone/Fax

Practice location:
  • Phone: 925-754-7200
  • Fax:
Mailing address:
  • Phone: 925-754-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA31325
License Number StateCA

VIII. Authorized Official

Name: ABBAS MAHDAVI
Title or Position: OWNER
Credential: MD
Phone: 925-754-1200