MEDICARE: DR. BAHNAM THOMAS D.O

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	208100000X	Physical Medicine & Rehabilitation Physician	20A8914	CA

General Provider Information

NPI Number	:	1841298718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAHNAM THOMAS D.O

Provider Business Mailing Address
First Line	:	27475 YNEZ RD STE 295
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92591-4612
Country	:	US
Telephone Number	:	951-894-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	28078 BAXTER RD STE 128
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-1403
Country	:	US
Telephone Number	:	951-894-5000
Fax Number	:

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	06/25/2012

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