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General NPI Number Information
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NPI Number | 1487821757
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Entity Type | Organization
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Legal Business Name | B. ROBERT BAMSHAD, M.D., INC.
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 8635 W 3RD ST SUITE 765W
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City | LOS ANGELES
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State | CA
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Zip | 90048-6101
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Country | US
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Telephone | 310-854-0777
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Fax | 310-289-5198
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Provider Business Mailing Address
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Address Line | 8635 W 3RD ST SUITE 765W
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City | LOS ANGELES
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State | CA
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Zip | 90048-6101
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Country | US
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Telephone | 310-854-0777
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Fax | 310-289-5198
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BABAK ROBERT BAMSHAD
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Credential | M.D.
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Telephone | 310-854-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | G81239
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License Number State | CA
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