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NPI Code Detail

MEDICARE: REZA EHSANIAN MD

MEDICARE: REZA EHSANIAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation PhysicianMD2021-0789NM

General Provider Information

NPI Number : 1376988535
Entity Type Code : Individual
Provider Name (Legal Business Name) : REZA EHSANIAN MD
Provider Business Mailing Address
First Line : PO BOX 91902
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87199-1902
Country : US
Telephone Number : 505-585-5352
Fax Number : 505-485-0768
Provider Business Practice Location Address
First Line : 2211 LOMAS BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87106-2719
Country : US
Telephone Number : 505-272-1111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2013
Last Update Date : 06/24/2026

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