Provider Demographics
NPI:1689780710
Name:BABAPOUR, REZA (MD)
Entity Type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:BABAPOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N CAMDEN DR
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4532
Mailing Address - Country:US
Mailing Address - Phone:310-247-0337
Mailing Address - Fax:310-247-0343
Practice Address - Street 1:414 N CAMDEN DR
Practice Address - Street 2:SUITE 1001
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4532
Practice Address - Country:US
Practice Address - Phone:310-247-0337
Practice Address - Fax:310-247-0343
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77137207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G771370OtherBLUE SHIELD
CAWG77137DMedicare ID - Type Unspecified
CA00G771370OtherBLUE SHIELD