Provider Demographics
NPI:1194248252
Name:MOHAMMAD REZA HOJJATI MD PHD PLLC
Entity type:Organization
Organization Name:MOHAMMAD REZA HOJJATI MD PHD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:HOJJATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:480-476-8750
Mailing Address - Street 1:PO BOX 756
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85244-0756
Mailing Address - Country:US
Mailing Address - Phone:480-476-8750
Mailing Address - Fax:480-476-8749
Practice Address - Street 1:3100 W RAY RD STE 201
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2472
Practice Address - Country:US
Practice Address - Phone:480-476-8750
Practice Address - Fax:480-476-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46481207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ722920Medicaid