Provider Demographics
NPI:1679111710
Name:KALHOR, REZA (NMD)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:KALHOR
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 E RIO SALADO PKWY APT 3001
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-7480
Mailing Address - Country:US
Mailing Address - Phone:949-444-3755
Mailing Address - Fax:
Practice Address - Street 1:2140 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1751
Practice Address - Country:US
Practice Address - Phone:480-858-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CAND1534175F00000X
AZ25-1912175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician