Provider Demographics
NPI:1437129764
Name:RAMIN, ATA O (MD)
Entity Type:Individual
Prefix:DR
First Name:ATA
Middle Name:O
Last Name:RAMIN
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 1:12922 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2924
Mailing Address - Country:US
Mailing Address - Phone:818-760-2800
Mailing Address - Fax:818-760-7343
Practice Address - Street 1:12922 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-2924
Practice Address - Country:US
Practice Address - Phone:818-760-2800
Practice Address - Fax:818-760-7343
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42405207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A424051Medicaid
CAZZZ24912ZOtherBLUE SHIELD INSURANCE ID
CAZZZ24912ZOtherBLUE SHIELD INSURANCE ID
CAB50489Medicare UPIN