Healthcare Provider Details

I. General information

NPI: 1205148574
Provider Name (Legal Business Name): RAMBOD CHAREPOO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9888 GENESEE AVE
LA JOLLA CA
92037-1205
US

IV. Provider business mailing address

11225 LEE WAY APT 16113
SAN DIEGO CA
92126-3081
US

V. Phone/Fax

Practice location:
  • Phone: 858-626-4123
  • Fax:
Mailing address:
  • Phone: 770-842-8798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA-152206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: