Healthcare Provider Details

I. General information

NPI: 1619141413
Provider Name (Legal Business Name): ROOZBEH HOUSHYAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

1026 BIG BEND DR
PACIFICA CA
94044-3809
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7237
  • Fax:
Mailing address:
  • Phone: 714-390-5772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA118157
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA118157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: