Healthcare Provider Details

I. General information

NPI: 1285845420
Provider Name (Legal Business Name): MOHTARAM ROSHANIAN RDMS (AB OB)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 WOODMAN AVE
ARLETA CA
91331-6401
US

IV. Provider business mailing address

2157 HILLSBURY RD
WESTLAKE VILLAGE CA
91361-3552
US

V. Phone/Fax

Practice location:
  • Phone: 818-830-7033
  • Fax:
Mailing address:
  • Phone: 805-279-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number33111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: