Healthcare Provider Details

I. General information

NPI: 1619304870
Provider Name (Legal Business Name): ROSEMINA MEHRDADY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5042 WILSHIRE BLVD 28700 UNIT #43
LOS ANGELES CA
90036-4305
US

IV. Provider business mailing address

11234 ANDERSON ST
LOMA LINDA CA
92354
US

V. Phone/Fax

Practice location:
  • Phone: 714-924-4552
  • Fax:
Mailing address:
  • Phone: 714-924-4552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: