Provider Demographics
NPI:1619304870
Name:MEHRDADY, ROSEMINA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMINA
Middle Name:
Last Name:MEHRDADY
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 1:11234 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:714-924-4552
Mailing Address - Fax:
Practice Address - Street 1:5042 WILSHIRE BLVD
Practice Address - Street 2:28700 UNIT #43
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4305
Practice Address - Country:US
Practice Address - Phone:714-924-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1744R1102XOther Service ProvidersSpecialistResearch Study