Healthcare Provider Details

I. General information

NPI: 1861558918
Provider Name (Legal Business Name): RUDY ROBERT REZZADEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 WESTWOOD BLVD SUITE 220
LOS ANGELES CA
90025-4650
US

IV. Provider business mailing address

1990 WESTWOOD BLVD STE 220
LOS ANGELES CA
90025-4674
US

V. Phone/Fax

Practice location:
  • Phone: 424-832-7110
  • Fax: 424-832-7113
Mailing address:
  • Phone: 424-832-7110
  • Fax: 424-832-7113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC55967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: