Healthcare Provider Details

I. General information

NPI: 1619936556
Provider Name (Legal Business Name): ROSHANAK EFTEKHARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VERMONT AVE SUITE# 807
LOS ANGELES CA
90027-6005
US

IV. Provider business mailing address

1300 N VERMONT AVE SUITE# 807
LOS ANGELES CA
90027-6005
US

V. Phone/Fax

Practice location:
  • Phone: 323-660-5191
  • Fax: 323-660-6513
Mailing address:
  • Phone: 323-660-5191
  • Fax: 323-660-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA76119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: