Provider Demographics
NPI:1750774923
Name:GHASEMIESFE, AHMADREZA (MD)
Entity type:Individual
Prefix:DR
First Name:AHMADREZA
Middle Name:
Last Name:GHASEMIESFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 CROCKER DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-3964
Mailing Address - Country:US
Mailing Address - Phone:312-395-0993
Mailing Address - Fax:
Practice Address - Street 1:3233 CROCKER DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-3964
Practice Address - Country:US
Practice Address - Phone:312-395-0993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1669962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology