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General NPI Number Information
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NPI Number | 1366659625
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Entity Type | Individual
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Provider Name | ALIREZA HAYATSHAHI PHARMD, BCPS, BCIDP
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 24745 STEWART STREET SHRYOCK HALL
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City | LOMA LINDA
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State | CA
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Zip | 92350-6709
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Country | US
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Telephone | 909-558-5817
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Fax |
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Provider Business Mailing Address
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Address Line | 451 SONORA CIR
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City | REDLANDS
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State | CA
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Zip | 92373-8509
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Country | US
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Telephone | 714-742-0795
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Fax |
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 76011
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License Number State | CA
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