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General NPI Number Information
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NPI Number | 1992751440
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Entity Type | Organization
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Legal Business Name | BABAK ROSHDIEH, M.D. CORP.
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 770 MAGNOLIA AVE SUITE 2G
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City | CORONA
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State | CA
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Zip | 92879-3120
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Country | US
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Telephone | 951-734-6500
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Fax | 951-734-6555
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Provider Business Mailing Address
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Address Line | 770 MAGNOLIA AVE SUITE 2G
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City | CORONA
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State | CA
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Zip | 92879-3120
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Country | US
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Telephone | 951-734-6500
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Fax | 951-734-6555
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Authorized Official
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Title or Position | OWNER
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Name | BABAK ROSHDIEH
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Credential | M.D.
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Telephone | 951-734-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A76333
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License Number State | CA
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