Healthcare Provider Details

I. General information

NPI: 1992842918
Provider Name (Legal Business Name): ABBAS MAHDAVI MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 LONE TREE WAY 211
ANTIOCH CA
94509
US

IV. Provider business mailing address

3903 LONE TREE WAY 211
ANTIOCH CA
94509
US

V. Phone/Fax

Practice location:
  • Phone: 925-754-7200
  • Fax: 925-754-7290
Mailing address:
  • Phone: 925-754-7200
  • Fax: 925-754-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA313250
License Number StateCA

VIII. Authorized Official

Name: MR. ABBAS MAHDAVI
Title or Position: OWNER
Credential: MD
Phone: 925-754-7200