Provider Demographics
NPI:1083881841
Name:BAHRAMI, GHAZALEH (MD)
Entity Type:Individual
Prefix:
First Name:GHAZALEH
Middle Name:
Last Name:BAHRAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-0088
Mailing Address - Country:US
Mailing Address - Phone:562-869-4497
Mailing Address - Fax:562-869-6317
Practice Address - Street 1:11525 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4985
Practice Address - Country:US
Practice Address - Phone:562-869-4497
Practice Address - Fax:562-869-6317
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117471207R00000X
WI54264-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine