Individual
SEYED MOHAMMAD REZA KHODDAMI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2705 LOMA VISTA RD, SUITE 206, VENTURA, CA 93003-1581
(805) 643-4067
(805) 643-4587
Mailing address
5855 OLIVAS PARK DR, VENTURA, CA 93003-7672
(805) 667-2801
(805) 667-2865
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
A109665
CA
2088P0231X
Pediatric Urology Physician
A109665
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A109665
CALIFORNIA STATE
CA
Enumeration date
03/28/2007
Last updated
06/01/2012
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