Provider Demographics
NPI:1619001245
Name:SHAHNAZ KERAMATI M D INC
Entity Type:Organization
Organization Name:SHAHNAZ KERAMATI M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KERAMATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-672-9852
Mailing Address - Street 1:10507 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90304-1911
Mailing Address - Country:US
Mailing Address - Phone:310-672-9852
Mailing Address - Fax:310-672-9853
Practice Address - Street 1:10507 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90304-1911
Practice Address - Country:US
Practice Address - Phone:310-672-9852
Practice Address - Fax:310-672-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization