Healthcare Provider Details

I. General information

NPI: 1679193221
Provider Name (Legal Business Name): NAVID MAHABADI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23823 VALENCIA BLVD STE 230
VALENCIA CA
91355-9512
US

IV. Provider business mailing address

PO BOX 55115
VALENCIA CA
91385-0115
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-0172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A21906
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: