Healthcare Provider Details

I. General information

NPI: 1497742555
Provider Name (Legal Business Name): MOHAMMAD H RAHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12365 N VIA TUSCANIA
CLOVIS CA
93619
US

IV. Provider business mailing address

12365 N VIA TUSCANIA
CLOVIS CA
93619
US

V. Phone/Fax

Practice location:
  • Phone: 314-878-7988
  • Fax: 314-878-7988
Mailing address:
  • Phone: 314-878-7988
  • Fax: 314-878-7988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number34881
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: