Healthcare Provider Details

I. General information

NPI: 1982477634
Provider Name (Legal Business Name): REZA RASOULI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 EUCLID ST
FOUNTAIN VALLEY CA
92708-4004
US

IV. Provider business mailing address

751 S WEIR CANYON RD STE 157-283
ANAHEIM CA
92808-1962
US

V. Phone/Fax

Practice location:
  • Phone: 714-298-8118
  • Fax:
Mailing address:
  • Phone: 714-298-8118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: REZA RASOULI
Title or Position: CEO
Credential: MD
Phone: 714-298-8118