Healthcare Provider Details

I. General information

NPI: 1194837161
Provider Name (Legal Business Name): ROXANA HEIDI YOONESSI-MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROXANA HEIDI YOONESSI M.D.

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13652 CANTARA ST
PANORAMA CITY CA
91402-5423
US

IV. Provider business mailing address

13652 CANTARA ST
PANORAMA CITY CA
91402-5423
US

V. Phone/Fax

Practice location:
  • Phone: 818-375-2013
  • Fax:
Mailing address:
  • Phone: 818-375-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberML20008729
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA103004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: