Provider Demographics
NPI:1144331224
Name:MEHRDAD AMIRHAMZEH, M.D., INC.
Entity type:Organization
Organization Name:MEHRDAD AMIRHAMZEH, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRHAMZEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-665-4412
Mailing Address - Street 1:1610 W YOSEMITE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-5189
Mailing Address - Country:US
Mailing Address - Phone:209-665-4412
Mailing Address - Fax:209-665-4415
Practice Address - Street 1:1610 W YOSEMITE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5189
Practice Address - Country:US
Practice Address - Phone:209-665-4412
Practice Address - Fax:209-665-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86572208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G865720Medicaid
ZZZ03769ZOtherMEDICARE PTAN
CA00G865720Medicaid
ZZZ03769ZMedicare PIN