Healthcare Provider Details

I. General information

NPI: 1861273161
Provider Name (Legal Business Name): ROUZITA RASHTIAN DDS A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 WILSHIRE BLVD STE 204
LOS ANGELES CA
90025-1241
US

IV. Provider business mailing address

12301 WILSHIRE BLVD STE 204
LOS ANGELES CA
90025-1241
US

V. Phone/Fax

Practice location:
  • Phone: 310-622-1617
  • Fax:
Mailing address:
  • Phone: 310-622-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROUZITA RASHTIAN
Title or Position: DOCTOR/AUTHORIZED OFFICIAL
Credential: DDS
Phone: 310-622-1617