MEDICARE: MEHRDAD REZAEE MD PHD

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
1	207RC0000X	Cardiovascular Disease Physician	G83930	CA

General Provider Information

NPI Number	:	1629056692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEHRDAD REZAEE MD PHD

Provider Business Mailing Address
First Line	:	2030 FOREST AVE
Second Line	:	SUITE 210
City	:	SAN JOSE
State	:	CA
Zip	:	95128-4833
Country	:	US
Telephone Number	:	408-295-2257
Fax Number	:	408-295-2264

Provider Business Practice Location Address
First Line	:	2030 FOREST AVE
Second Line	:	SUITE 210
City	:	SAN JOSE
State	:	CA
Zip	:	95128-4833
Country	:	US
Telephone Number	:	408-295-2257
Fax Number	:	408-295-2264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	02/27/2012

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