Healthcare Provider Details

I. General information

NPI: 1609857788
Provider Name (Legal Business Name): MEHRDAD RAZAVI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 VICTOR AVE
REDDING CA
96003-4031
US

IV. Provider business mailing address

1505 VICTOR AVE
REDDING CA
96003-4031
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-9273
  • Fax: 530-242-5873
Mailing address:
  • Phone: 530-242-9273
  • Fax: 530-242-5873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberMD60101049
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberC53033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: