Healthcare Provider Details

I. General information

NPI: 1306183660
Provider Name (Legal Business Name): SHADI REZAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VALLEY COMMUNITY HEALTHCARE 6801 COLDWATER CANYON AVENUE
NORTH HOLLYWOOD CA
91605
US

IV. Provider business mailing address

VALLEY COMMUNITY HEALTHCARE, DEPARTMENT OF OB/GYN 6801 COLDWATER CANYON AVENUE
NORTH HOLLYWOOD CA
91605
US

V. Phone/Fax

Practice location:
  • Phone: 818-763-8836
  • Fax:
Mailing address:
  • Phone: 818-763-8836
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA143477
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberR5801
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: