Healthcare Provider Details

I. General information

NPI: 1790289288
Provider Name (Legal Business Name): VANIA RASHIDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY BLDG 720
MATHER CA
95655-4200
US

IV. Provider business mailing address

10535 HOSPITAL WAY BLDG 720
MATHER CA
95655-4200
US

V. Phone/Fax

Practice location:
  • Phone: 916-366-5463
  • Fax:
Mailing address:
  • Phone: 916-366-5463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA196686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: