Healthcare Provider Details

I. General information

NPI: 1558665737
Provider Name (Legal Business Name): ROSTAM KHOUBYARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 LAKEWOOD BLVD
DOWNEY CA
90240-4020
US

IV. Provider business mailing address

12900 PARK PLAZA DR STE 150
CERRITOS CA
90703-9329
US

V. Phone/Fax

Practice location:
  • Phone: 562-862-3684
  • Fax:
Mailing address:
  • Phone: 562-977-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number47772
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA127733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: