Healthcare Provider Details

I. General information

NPI: 1568679785
Provider Name (Legal Business Name): R BAYATI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 WARD LN
ROCKLIN CA
95677-2842
US

IV. Provider business mailing address

5120 WARD LN
ROCKLIN CA
95677-2842
US

V. Phone/Fax

Practice location:
  • Phone: 916-626-4838
  • Fax: 916-626-4837
Mailing address:
  • Phone: 916-626-4838
  • Fax: 916-626-4837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4301066754
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberC52426
License Number StateCA

VIII. Authorized Official

Name: DR. REZA BAYATI
Title or Position: DIRECTOR
Credential: MD
Phone: 916-626-4838