Provider Demographics
NPI:1043361546
Name:RASEKHI, MOHAMMAD H (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:H
Last Name:RASEKHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:RASEKHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12100 VALLEY BLVD
Mailing Address - Street 2:SUITE#109A
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3100
Mailing Address - Country:US
Mailing Address - Phone:626-575-7500
Mailing Address - Fax:626-575-1956
Practice Address - Street 1:14550 HAYNES ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1613
Practice Address - Country:US
Practice Address - Phone:818-650-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48861207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A488610Medicaid
CABR2563307OtherDEA
CABR2563307OtherDEA