Provider Demographics
NPI:1578566030
Name:MONSHIZADEH, RAMIN (MD)
Entity Type:Individual
Prefix:
First Name:RAMIN
Middle Name:
Last Name:MONSHIZADEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8577 HAVEN AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4850
Mailing Address - Country:US
Mailing Address - Phone:909-944-5353
Mailing Address - Fax:909-944-4975
Practice Address - Street 1:8577 HAVEN AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4850
Practice Address - Country:US
Practice Address - Phone:909-944-5353
Practice Address - Fax:909-944-4975
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86057207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G63834Medicare UPIN
CA00G860573Medicare ID - Type Unspecified