Healthcare Provider Details

I. General information

NPI: 1275739302
Provider Name (Legal Business Name): MORTEZA RAHMANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N 8TH ST
EL CENTRO CA
92243-2302
US

IV. Provider business mailing address

202 N 8TH ST
EL CENTRO CA
92243-2302
US

V. Phone/Fax

Practice location:
  • Phone: 760-482-4178
  • Fax:
Mailing address:
  • Phone: 760-482-4178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA119345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: