Healthcare Provider Details

I. General information

NPI: 1326329012
Provider Name (Legal Business Name): REZA TADAYON-NEJAD M.D., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8835 VANS ST LA PAZ GEROPSYCHIATRIC CENTER
PARAMOUNT CA
90723-4656
US

IV. Provider business mailing address

8835 VANS ST LA PAZ GEROPSYCHIATRIC CENTER
PARAMOUNT CA
90723-4656
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-5111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA137573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: