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
State | License ID | Taxonomies |
---|---|---|
CA | A99811 | 261QP2300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |