Provider Demographics
NPI:1518193267
Name:HELEN ROSTAMLOO MD INC
Entity Type:Organization
Organization Name:HELEN ROSTAMLOO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSTAMLOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-244-3520
Mailing Address - Street 1:800 S CENTRAL AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4370
Mailing Address - Country:US
Mailing Address - Phone:818-244-3520
Mailing Address - Fax:818-244-3533
Practice Address - Street 1:800 S CENTRAL AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4370
Practice Address - Country:US
Practice Address - Phone:818-244-3520
Practice Address - Fax:818-244-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99811261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care