Provider Demographics
NPI:1871802454
Name:ABDOLLAHZADEH, HOMAYOUN (MD)
Entity type:Individual
Prefix:
First Name:HOMAYOUN
Middle Name:
Last Name:ABDOLLAHZADEH
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 1:35400 BOB HOPE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1772
Mailing Address - Country:US
Mailing Address - Phone:760-833-7977
Mailing Address - Fax:866-455-0114
Practice Address - Street 1:35400 BOB HOPE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1772
Practice Address - Country:US
Practice Address - Phone:760-833-7977
Practice Address - Fax:866-455-0114
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA245851208M00000X, 207R00000X
CAA129821207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine