Healthcare Provider Details

I. General information

NPI: 1295926087
Provider Name (Legal Business Name): ROYA MASOUD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16415 COLORADO AVE 410
PARAMOUNT CA
90723-5084
US

IV. Provider business mailing address

16415 COLORADO AVE 140
PARAMOUNT CA
90723-5035
US

V. Phone/Fax

Practice location:
  • Phone: 562-529-2259
  • Fax:
Mailing address:
  • Phone: 562-529-5229
  • Fax: 562-529-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A10231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: