Healthcare Provider Details

I. General information

NPI: 1699005322
Provider Name (Legal Business Name): ROZBEH TORABI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10645 N. TATUM BLVD SUITE C200 #305
PHOENIX AZ
85028
US

IV. Provider business mailing address

10645 N. TATUM BLVD SUITE C200 #305
PHOENIX AZ
85028
US

V. Phone/Fax

Practice location:
  • Phone: 401-837-8851
  • Fax:
Mailing address:
  • Phone: 401-837-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number49766
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number49766
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number49766
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number49766
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number49766
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: