Provider Demographics
NPI:1861434235
Name:SANI, MAHMOUD HAMIDI (MD)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:HAMIDI
Last Name:SANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E FLORIDA AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-8643
Mailing Address - Country:US
Mailing Address - Phone:951-765-1766
Mailing Address - Fax:951-765-1770
Practice Address - Street 1:1600 E FLORIDA AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8643
Practice Address - Country:US
Practice Address - Phone:951-765-1766
Practice Address - Fax:951-765-1770
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33150207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0102090Medicaid
CAZZZ32049ZMedicare ID - Type Unspecified