MEDICARE: RAMBOD R. ALIREZAEI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	48872	CA

General Provider Information

NPI Number	:	1841455938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAMBOD R. ALIREZAEI

Provider Business Mailing Address
First Line	:	11633 SAN VICENTE BLVD STE 308
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6514
Country	:	US
Telephone Number	:	310-207-3707
Fax Number	:	310-207-3703

Provider Business Practice Location Address
First Line	:	11633 SAN VICENTE BLVD STE 308
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6514
Country	:	US
Telephone Number	:	310-207-3707
Fax Number	:	310-207-3703

Authorized Official
Title or Position	:	OWNER/ENDODONTIST
Name	:	DR. RAMBOD ROBBY ALIREZAEI
Credential	:	D.D.S.
Telephone Number	:	310-207-3707

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	07/28/2008

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