Healthcare Provider Details

I. General information

NPI: 1922294453
Provider Name (Legal Business Name): RAME D IBERDEMAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E ALMOND AVE 102
MADERA CA
93637-5693
US

IV. Provider business mailing address

1000 E ALMOND AVE 102
MADERA CA
93637-5693
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-5657
  • Fax: 559-549-9736
Mailing address:
  • Phone: 559-673-5657
  • Fax: 559-549-9736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number244781
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number37724
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA112001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: