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Organization
NEUROSURGICAL TRAUMA SERVICES
Active
Organization
NEUROSURGICAL TRAUMA SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BAHRAM CHEHRAZI MD (MEDICAL DIRECTOR)
(916) 771-3393
Entity
Organization
Contact information
Practice address
1301 SECRET RAVINE PKWY, STE 200, ROSEVILLE, CA 95661-3096
(916) 771-3393
Mailing address
PO BOX 2600, GRANITE BAY, CA 95746-2600
(916) 771-3393
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0070590
—
CA
01
—
ZZZ49984Z
BLUE SHIELD GROUP ID
CA
Enumeration date
01/31/2007
Last updated
12/31/2009
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