Individual provider Active NPI

Reza Vaezazizi, M.D.

  • Emergency Medicine Physician
  • Wildomar, CA
National Provider Identifier
1922042092
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A66886 Issued in CA
Practice address
36485 Inland Valley Drive
Wildomar, CA 92595
Phone
(951) 677-9712
NPI assigned
Jun 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A66886 CA Primary

Addresses

Primary practice location

36485 Inland Valley Drive
Wildomar, CA 92595

Mailing address

2100 Powell Street
Suite 900
Emeryville, CA 94608-1803
Phone (510) 350-2600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050208000311 CA Practitioner - Emergency Medicine 5597716514 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Em Alliance California ApcGroup PAC ID 1951749894, 68 clinicians

Practice addresses (Care Compare)

36485 Inland Valley Dr
Wildomar, CA 92595-9681
Phone (951) 677-1111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A66886CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America-California Emergency Medicine CurrentSince Jun 1, 2000 Accepting new patients
Em Alliance California, Apc Emergency Medicine CurrentSince Apr 16, 2024 Accepting new patients
Cep America - California Emergency Medicine CurrentSince Jun 1, 2000 Accepting new patients
Cep America - California Emergency Medicine Current Accepting new patients
Chino Emergency Medical Associates Emergency Medicine Past Accepting new patients

Locations

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

26520 Cactus Ave
Moreno Valley, CA 92555
Phone (951) 486-5610

25500 Medical Center Dr
Murrieta, CA 92562
Phone (951) 696-6000

38600 Medical Center Dr
Palmdale, CA 93551
Phone (661) 382-5000

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

36485 Inland Valley Dr
Wildomar, CA 92595
Phone (909) 677-9778

L4421
Columbus, OH 43260

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922042092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 POWELL STREET",
            "address_2": "SUITE 900",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081803",
            "telephone_number": "510-350-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36485 INLAND VALLEY DRIVE",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "92595",
            "telephone_number": "951-677-9712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAEZAZIZI",
        "first_name": "REZA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A66886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wildomar, CA

Sources for this page

Verify at the official NPI Registry.