1750311791 NPI number — BABAK ROOZROKH, MD INC

Table of content: (NPI 1750311791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750311791 NPI number — BABAK ROOZROKH, MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BABAK ROOZROKH, MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750311791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 WESTWOOD BLVD
Provider Second Line Business Mailing Address:
SUITE 2D
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90024-5608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-941-4161
Provider Business Mailing Address Fax Number:
310-234-6604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 WESTWOOD BLVD
Provider Second Line Business Practice Location Address:
SUITE 2D
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90024-5608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-941-4161
Provider Business Practice Location Address Fax Number:
310-234-6604
Provider Enumeration Date:
07/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROOZROKH
Authorized Official First Name:
BABAK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-475-4865

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A81646 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A816460 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".