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General NPI Number Information
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NPI Number | 1568848042
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Entity Type | Organization
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Legal Business Name | REZA KERMANI MD INCORPORATED
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 10/07/2023
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Provider Practice Location Address
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Address Line | 38920 TRADE CENTER DR
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City | PALMDALE
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State | CA
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Zip | 93551-3715
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Country | US
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Telephone | 612-554-4106
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Fax | 972-323-7840
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Provider Business Mailing Address
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Address Line | 35 E GLENARM ST
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City | PASADENA
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State | CA
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Zip | 91105-3418
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Country | US
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Telephone | 626-768-4415
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Fax | 626-403-0321
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Authorized Official
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Title or Position | PRESIDENT
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Name | REZA KERMANI
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Credential | M.D.
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Telephone | 310-920-6925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | A111955
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License Number State | CA
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