Healthcare Provider Details

I. General information

NPI: 1497087290
Provider Name (Legal Business Name): ROBERT IMANI MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W AVENUE J 103
LANCASTER CA
93534-2843
US

IV. Provider business mailing address

1505 W AVENUE J 103
LANCASTER CA
93534-2843
US

V. Phone/Fax

Practice location:
  • Phone: 818-571-5576
  • Fax:
Mailing address:
  • Phone: 818-571-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT BABAK IMANI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 818-571-5576