Provider Demographics
NPI:1639550130
Name:ROUBACH, MAJID (MD)
Entity Type:Individual
Prefix:
First Name:MAJID
Middle Name:
Last Name:ROUBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAJID
Other - Middle Name:
Other - Last Name:ROUHBAKHSHZAERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1899 W MARCH LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6402
Mailing Address - Country:US
Mailing Address - Phone:209-623-4700
Mailing Address - Fax:209-623-4710
Practice Address - Street 1:1899 W MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207
Practice Address - Country:US
Practice Address - Phone:209-623-4700
Practice Address - Fax:209-623-4710
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125067106390200000X
CAFR7717501207WX0110X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology