Healthcare Provider Details

I. General information

NPI: 1881687309
Provider Name (Legal Business Name): MOSTAFA S RAHIMI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOSTAFA S RAHIMI M.D

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 W 1ST ST
SAN PEDRO CA
90732-3255
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 310-241-2590
  • Fax:
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA89780
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA 89780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: