Provider Demographics
NPI:1477503563
Name:DERAMBAKHSH, MEHDI FARSHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHDI
Middle Name:FARSHAD
Last Name:DERAMBAKHSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:210 S PROSPECT AVE
Mailing Address - Street 2:#4
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6802
Mailing Address - Country:US
Mailing Address - Phone:310-218-6415
Mailing Address - Fax:818-528-2505
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:140
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2203
Practice Address - Country:US
Practice Address - Phone:818-528-2500
Practice Address - Fax:818-528-2505
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA88950207N00000X, 207ND0101X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine