Provider Demographics
NPI:1669755153
Name:RAHNAVARD, AMIR (DO)
Entity type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:RAHNAVARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80545 US HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-8367
Mailing Address - Country:US
Mailing Address - Phone:760-347-9221
Mailing Address - Fax:
Practice Address - Street 1:1451 RIMPAU AVE STE 213
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-7522
Practice Address - Country:US
Practice Address - Phone:951-268-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15779207R00000X
FLUO2771207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty