Healthcare Provider Details

I. General information

NPI: 1568442986
Provider Name (Legal Business Name): MASOOMEH DJODEIR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 AIRPORT PLAZA DR STE 100
LONG BEACH CA
90815-1377
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 562-429-2473
  • Fax:
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-4151
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: