Provider Demographics
NPI:1437248820
Name:AHMADI, BEHROOZ (MD)
Entity Type:Individual
Prefix:DR
First Name:BEHROOZ
Middle Name:
Last Name:AHMADI
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 1:5451 LA PALMA AVE
Mailing Address - Street 2:#34
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1728
Mailing Address - Country:US
Mailing Address - Phone:714-739-5816
Mailing Address - Fax:714-739-2450
Practice Address - Street 1:5451 LA PALMA AVE
Practice Address - Street 2:#34
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1728
Practice Address - Country:US
Practice Address - Phone:714-739-5816
Practice Address - Fax:714-739-2450
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22029174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A220291Medicaid
CA00A220291Medicaid
CAA22029AMedicare ID - Type Unspecified