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General NPI Number Information
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NPI Number | 1831569987
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Entity Type | Organization
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Legal Business Name | REZA BASHTAR MD, INC
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 1 HOAG DR
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4162
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Country | US
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Telephone | 858-208-6550
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Fax | 714-685-1567
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Provider Business Mailing Address
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Address Line | 13204 TELMO
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City | IRVINE
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State | CA
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Zip | 92618-0281
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | REZA BASHTAR
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Credential | MD
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Telephone | 858-208-6550
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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 | A119388
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License Number State | CA
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