Provider Demographics
NPI:1538316740
Name:MAHMOUDI, ROUHANGIZ
Entity Type:Individual
Prefix:
First Name:ROUHANGIZ
Middle Name:
Last Name:MAHMOUDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 CASCARA CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0205
Mailing Address - Country:US
Mailing Address - Phone:805-306-9616
Mailing Address - Fax:
Practice Address - Street 1:6931 VAN NUYS BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3937
Practice Address - Country:US
Practice Address - Phone:818-374-6901
Practice Address - Fax:818-374-6908
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner