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General NPI Number Information
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NPI Number | 1437791704
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Entity Type | Organization
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Legal Business Name | M T REZAI PC
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 27154 SEA VISTA DR
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City | MALIBU
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State | CA
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Zip | 90265-4437
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Country | US
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Telephone | 818-458-0917
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Fax |
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Provider Business Mailing Address
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Address Line | 455 E THOUSAND OAKS BLVD STE B
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5800
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Country | US
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Telephone | 818-232-5788
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. MOHAMMED REZAI
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Credential | DO
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Telephone | 818-458-0917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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