Provider Demographics
NPI:1114064987
Name:ROSTAMI, NEJAT (MD)
Entity Type:Individual
Prefix:
First Name:NEJAT
Middle Name:
Last Name:ROSTAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2310
Mailing Address - Country:US
Mailing Address - Phone:323-957-8787
Mailing Address - Fax:323-957-8777
Practice Address - Street 1:1080 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2310
Practice Address - Country:US
Practice Address - Phone:323-957-8787
Practice Address - Fax:323-957-8787
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48731174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA487310Medicaid
CAOOA487310Medicaid
CAE66967Medicare UPIN