Provider Demographics
NPI:1992052369
Name:ALLAMEH MEDICAL CORPORATION
Entity type:Organization
Organization Name:ALLAMEH MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLAMEHZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-922-9170
Mailing Address - Street 1:24881 ALICIA PKWY
Mailing Address - Street 2:STE. E-467
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4617
Mailing Address - Country:US
Mailing Address - Phone:949-581-2002
Mailing Address - Fax:949-581-2221
Practice Address - Street 1:24881 ALICIA PKWY
Practice Address - Street 2:UNIT N
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4617
Practice Address - Country:US
Practice Address - Phone:949-581-2002
Practice Address - Fax:949-581-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-05
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102735207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA102735OtherSTATE LIC. #
CAZZZ70903YOtherBLUE SHIELD
CAA102735OtherSTATE LIC. #