Provider Demographics
NPI:1679890339
Name:JAVANMARDI, HOOMAN MEHDI
Entity type:Individual
Prefix:
First Name:HOOMAN
Middle Name:MEHDI
Last Name:JAVANMARDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MEHDI
Other - Middle Name:HOOMAN
Other - Last Name:JAVANMARDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:3427 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3254
Mailing Address - Country:US
Mailing Address - Phone:951-684-2865
Mailing Address - Fax:
Practice Address - Street 1:3427 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3254
Practice Address - Country:US
Practice Address - Phone:951-684-2865
Practice Address - Fax:951-934-0555
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist