Provider Demographics
NPI:1568442986
Name:DJODEIR, MASOOMEH (MD)
Entity Type:Individual
Prefix:
First Name:MASOOMEH
Middle Name:
Last Name:DJODEIR
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 1:2925 NORTH PALO VERDE AVE.
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815
Mailing Address - Country:US
Mailing Address - Phone:562-429-2473
Mailing Address - Fax:562-496-5577
Practice Address - Street 1:2925 NORTH PALO VERDE AVE.
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815
Practice Address - Country:US
Practice Address - Phone:562-429-2473
Practice Address - Fax:562-496-5577
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR05070016600OtherQUAL CHOICE
AR2563342OtherUNITED HEALTH CARE
AR157173001Medicaid
AR7484660OtherAETNA
AR5652522OtherFIRST HEALTH
AR5N077OtherBCBS
AR5652522OtherFIRST HEALTH
AR2563342OtherUNITED HEALTH CARE