Healthcare Provider Details

I. General information

NPI: 1679594519
Provider Name (Legal Business Name): RANA BAROUDI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 IRVING ST
SAN FRANCISCO CA
94122-1908
US

IV. Provider business mailing address

788 HARRISON ST APT 627
SAN FRANCISCO CA
94107-4212
US

V. Phone/Fax

Practice location:
  • Phone: 415-205-7311
  • Fax:
Mailing address:
  • Phone: 415-205-7311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number53757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: