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NPI Code Detail

MEDICARE: DR. MOHAMMAD REZA DANESH M.D.

MEDICARE: DR. MOHAMMAD REZA DANESH M.D.
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
1207Q00000XFamily Medicine PhysicianA048943CA

General Provider Information

NPI Number : 1811999261
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MOHAMMAD REZA DANESH M.D.
Provider Business Mailing Address
First Line : 31581 CANYON ESTATE DR
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-0242
Country : US
Telephone Number : 951-244-3500
Fax Number : 951-244-3535
Provider Business Practice Location Address
First Line : 31581 CANYON ESTATES DR
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-0424
Country : US
Telephone Number : 951-244-3500
Fax Number : 951-244-3535
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 10/25/2013

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