MEDICARE: ACCOLADE MEDICAL

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	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1922514710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCOLADE MEDICAL

Provider Business Mailing Address
First Line	:	275 W SAN BERNARDINO RD
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-1516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 W SAN BERNARDINO RD
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-1516
Country	:	US
Telephone Number	:	559-250-3393
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MEHRDAD GHAHREMANI-GHAJAR
Credential	:
Telephone Number	:	559-250-3393

Provider Enumeration Date	:	12/16/2017
Last Update Date	:	05/19/2026

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Directions to “ACCOLADE MEDICAL ” Practice Location

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