Provider Demographics
NPI:1609970318
Name:AMINBAKHSH, ROXANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:
Last Name:AMINBAKHSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROXANA
Other - Middle Name:
Other - Last Name:MOGHIMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:825 E BIDWELL ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4207
Mailing Address - Country:US
Mailing Address - Phone:858-900-6004
Mailing Address - Fax:
Practice Address - Street 1:825 E BIDWELL ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4207
Practice Address - Country:US
Practice Address - Phone:858-900-6004
Practice Address - Fax:775-327-5050
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10551207R00000X, 207RG0300X
CAC53405207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine