Organization
O FALLON MEDICAL VENTURES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MINOO RAHMINNEJAD (CFO)
(480) 926-7800
Entity
Organization
Contact information
Practice address
124 REGENCY PARK STE 7, O FALLON, IL 62269-1994
(480) 926-2260
Mailing address
2250 E GERMANN RD STE 8, CHANDLER, AZ 85286-1575
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
208D00000X
General Practice Physician
Primary
—
—
225100000X
Physical Therapist
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
05/15/2020
Last updated
05/15/2020
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