Healthcare Provider Details

I. General information

NPI: 1174750061
Provider Name (Legal Business Name): RUZMED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3756 SANTA ROSALIA DR SUITE 203B
LOS ANGELES CA
90008-3606
US

IV. Provider business mailing address

2658 GRIFFITH PARK BLVD SUITE 180
LOS ANGELES CA
90039-2520
US

V. Phone/Fax

Practice location:
  • Phone: 323-599-3303
  • Fax:
Mailing address:
  • Phone: 323-599-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA40818
License Number StateCA

VIII. Authorized Official

Name: KHOSROW MEHDI NAFISI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-599-3303