Healthcare Provider Details

I. General information

NPI: 1134523814
Provider Name (Legal Business Name): SIMIN KHARAZI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655
US

IV. Provider business mailing address

10535 HOSPITAL WAY
MATHER CA
95655
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-7000
  • Fax:
Mailing address:
  • Phone: 916-843-7000
  • Fax: 916-843-2631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA125833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: