Healthcare Provider Details

I. General information

NPI: 1780875393
Provider Name (Legal Business Name): HAMID REZA REDJAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CARRILLO ST
SANTA BARBARA CA
93101-1460
US

IV. Provider business mailing address

1523 CALLE PATRICIA
PACIFIC PALISADES CA
90272-1939
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-3307
  • Fax: 805-563-0998
Mailing address:
  • Phone: 573-388-3030
  • Fax: 573-335-8424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA99471
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2012037238
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: