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REZA BONABI MD INC NPI 1366607988


NPI Information

NPI: 1366607988
Provider Name: REZA BONABI MD, INC
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 05D0868792

Address:
17075 DEVONSHIRE ST
SUITE 301
NORTHRIDGE, CA
ZIP 91325
Phone: (818) 368-4212
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REZA BONABI MD, INC is a specialist in Northridge, CA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. REZA BONABI MD, INC NPI is 1366607988. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

17075 DEVONSHIRE ST
SUITE 301
NORTHRIDGE, CA
ZIP 91325-600
Phone: (818) 368-4212
Fax: (818) 366-9351

The provider's authorized official is Nagadeh Gholamreza Bonabi .
The authorized official title is Physician and has the following contact phone number (818) 368-4212.

The CLIA number assigned to this NPI record is 05D0868792 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/23/2008 and was last updated on 7/23/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistA46355CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1A46355MEDICARE PINCALIFORNIA
200A463550MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.