Provider Demographics
NPI:1619936556
Name:EFTEKHARI, ROSHANAK (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSHANAK
Middle Name:
Last Name:EFTEKHARI
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 1:1300 N VERMONT AVE
Mailing Address - Street 2:SUITE# 807
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6005
Mailing Address - Country:US
Mailing Address - Phone:323-660-5191
Mailing Address - Fax:323-660-6513
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:SUITE# 807
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-660-5191
Practice Address - Fax:323-660-6513
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619936556OtherNPI
CAWA76119AMedicaid
1619936556OtherNPI