Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A81646 | CA |
N | 111NI0900X | Internist | A81646 | CA |
Y | 207RH0002X | Hospice and Palliative Medicine | A81646 | CA |
NPI | 1326078361 |
---|---|
Provider Name | Babak Roozrokh |
First Address | Los Angeles, CA 90024-5608 |
Second Address | Los Angeles, CA 90024-5608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 25/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A81646 | CA LICENCE (01) | CA |
W18289 | MEDICARE PROVIDER NUMBER (01) | CA |