Provider Demographics
NPI:1033444229
Name:ALIREZA TEHRANI, D.O. INC
Entity type:Organization
Organization Name:ALIREZA TEHRANI, D.O. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEHRANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-240-2444
Mailing Address - Street 1:17868 US HIGHWAY 18
Mailing Address - Street 2:#357
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1267
Mailing Address - Country:US
Mailing Address - Phone:760-946-5177
Mailing Address - Fax:760-946-5133
Practice Address - Street 1:18064 WIKA RD
Practice Address - Street 2:UNIT 103
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2125
Practice Address - Country:US
Practice Address - Phone:760-240-2444
Practice Address - Fax:760-240-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty