Provider Demographics
NPI:1174523096
Name:AMIRHAMZEH, MEHRDAD MR (MD)
Entity type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:MR
Last Name:AMIRHAMZEH
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG86572208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00014381OtherRAILROAD MEDICARE ID
CA00G865720Medicaid
CA00G865720Medicaid
ZZZ03769ZMedicare PIN