Healthcare Provider Details

I. General information

NPI: 1265786552
Provider Name (Legal Business Name): ARTIN MAHMOUDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 01/13/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOSPITAL DR SONORA REGIONAL MEDICAL CENTER
UKIAH CA
95482
US

IV. Provider business mailing address

338 NE 105TH AVE
HILLSBORO OR
97006-7638
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-3111
  • Fax:
Mailing address:
  • Phone: 209-288-9874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG63126
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG63126
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number27589
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: