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General NPI Number Information
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NPI Number | 1568679785
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Entity Type | Organization
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Legal Business Name | R BAYATI MD PC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 5120 WARD LN
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City | ROCKLIN
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State | CA
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Zip | 95677-2842
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Country | US
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Telephone | 916-626-4838
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Fax | 916-626-4837
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Provider Business Mailing Address
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Address Line | 5120 WARD LN
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City | ROCKLIN
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State | CA
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Zip | 95677-2842
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Country | US
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Telephone | 916-626-4838
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Fax | 916-626-4837
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. REZA BAYATI
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Credential | MD
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Telephone | 916-626-4838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | C52426
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4301066754
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License Number State | MI
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