Healthcare Provider Details

I. General information

NPI: 1043689037
Provider Name (Legal Business Name): RAMELLA ROSTAMOU BABAYOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2015
Last Update Date: 09/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10525 CHURCHILL AVE
CHATSWORTH CA
91311-2231
US

IV. Provider business mailing address

10525 CHURCHILL AVE
CHATSWORTH CA
91311-2231
US

V. Phone/Fax

Practice location:
  • Phone: 818-439-3518
  • Fax:
Mailing address:
  • Phone: 818-439-3518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: