Individual
REZA KHODADADI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
638 CAMINO DE LOS MARES, SAN CLEMENTE, CA 92673-2848
(949) 487-9791
Mailing address
17252 CHESTNUT, IRVINE, CA 92612-2351
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
01/05/2020
Last updated
01/05/2020
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