Provider Demographics
NPI:1922832484
Name:REZA PIRSAHELI MD MEDICAL AND NEUROLOGICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:REZA PIRSAHELI MD MEDICAL AND NEUROLOGICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIRSAHELI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-490-1009
Mailing Address - Street 1:5555 MACARGO ST
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-9036
Mailing Address - Country:US
Mailing Address - Phone:310-490-1009
Mailing Address - Fax:
Practice Address - Street 1:100 IRON POINT CIR STE 103
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8596
Practice Address - Country:US
Practice Address - Phone:916-907-0002
Practice Address - Fax:940-301-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty