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General NPI Number Information
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NPI Number | 1629056692
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Entity Type | Individual
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Provider Name | MEHRDAD REZAEE MD PHD
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Gender | Male
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 2030 FOREST AVE SUITE 210
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City | SAN JOSE
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State | CA
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Zip | 95128-4833
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Country | US
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Telephone | 408-295-2257
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Fax | 408-295-2264
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Provider Business Mailing Address
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Address Line | 2030 FOREST AVE SUITE 210
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City | SAN JOSE
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State | CA
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Zip | 95128-4833
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Country | US
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Telephone | 408-295-2257
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Fax | 408-295-2264
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G83930
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License Number State | CA
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