Provider Demographics
NPI:1497938039
Name:AFROOZ, IMAN (MD)
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:
Last Name:AFROOZ
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 1:1015 9TH ST
Mailing Address - Street 2:#306
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4101
Mailing Address - Country:US
Mailing Address - Phone:949-395-8936
Mailing Address - Fax:
Practice Address - Street 1:520 N PROSPECT AVE
Practice Address - Street 2:103
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3041
Practice Address - Country:US
Practice Address - Phone:310-376-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048921207R00000X
CAA104989207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine