Provider Demographics
NPI:1780875393
Name:REDJAL, HAMID REZA (MD)
Entity type:Individual
Prefix:DR
First Name:HAMID
Middle Name:REZA
Last Name:REDJAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1523 CALLE PATRICIA
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1939
Mailing Address - Country:US
Mailing Address - Phone:573-388-3030
Mailing Address - Fax:573-335-8424
Practice Address - Street 1:401 E CARRILLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1460
Practice Address - Country:US
Practice Address - Phone:805-563-3307
Practice Address - Fax:805-563-0998
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA99471207X00000X
MO2012037238207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA99471OtherDCA MEDICAL LICENSE