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General NPI Number Information
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NPI Number | 1144144023
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Entity Type | Organization
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Legal Business Name | RADIANT PATH THERAPY AND PSYCHIATRY MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/05/2026
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Last Update Date | 08/05/2026
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Provider Practice Location Address
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Address Line | 4226 GREEN RIVER RD STE 201
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City | CORONA
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State | CA
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Zip | 92878-3829
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Country | US
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Telephone | 909-577-1123
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Fax |
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Provider Business Mailing Address
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Address Line | 308 W STATE ST STE 3D
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City | REDLANDS
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State | CA
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Zip | 92373-4653
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Country | US
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Telephone | 909-577-1123
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LANDON S EHTESHAMZADEH
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Credential |
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Telephone | 909-577-1123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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