Provider Demographics
NPI:1902890296
Name:MEHDI, RAZA (MD)
Entity Type:Individual
Prefix:
First Name:RAZA
Middle Name:
Last Name:MEHDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2409 ARTESIA BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40663 MURRIETA HOT SPRINGS RD STE C3
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9015
Practice Address - Country:US
Practice Address - Phone:951-677-5341
Practice Address - Fax:951-387-8004
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC55124207N00000X, 207Q00000X
IL036095111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC55124OtherCALIFORNIA MEDICAL LICENSE