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General NPI Number Information
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NPI Number | 1447239744
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Entity Type | Individual
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Provider Name | MOBIN P GHAVAMI M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 900 S FAIRMONT AVE STE. A
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City | LODI
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State | CA
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Zip | 95240-5119
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Country | US
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Telephone | 209-333-2500
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Fax | 209-333-3779
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Provider Business Mailing Address
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Address Line | PO BOX 331
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City | WOODBRIDGE
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State | CA
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Zip | 95258-0331
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Country | US
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Telephone | 209-333-2500
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Fax | 209-333-3779
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A54317
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License Number State | CA
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