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General NPI Number Information
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NPI Number | 1134657943
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Entity Type | Individual
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Provider Name | ROOZBEH A. AHMADI M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2017
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 1117 W TOKAY ST STE A
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City | LODI
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State | CA
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Zip | 95240-3844
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Country | US
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Telephone | 209-484-3000
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Fax | 209-273-2722
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Provider Business Mailing Address
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Address Line | PO BOX 1462
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City | HUGHSON
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State | CA
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Zip | 95326-1462
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Country | US
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Telephone | 209-448-3000
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Fax | 209-273-2722
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | T8744
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | T8744
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | A166182
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License Number State | CA
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