Provider Demographics
NPI:1619301488
Name:ROFOOGARAN, MOHSEN (DO)
Entity Type:Individual
Prefix:DR
First Name:MOHSEN
Middle Name:
Last Name:ROFOOGARAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9961 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6720
Mailing Address - Country:US
Mailing Address - Phone:190-930-2620
Mailing Address - Fax:
Practice Address - Street 1:3605 LONG BEACH BLVD STE 405
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4026
Practice Address - Country:US
Practice Address - Phone:562-424-8000
Practice Address - Fax:562-424-8006
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10775207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine