Provider Demographics
NPI:1750301008
Name:HOUMAN, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:HOUMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BEHROUZ
Other - Middle Name:HOUMAN
Other - Last Name:TABEBZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1820 FULLERTON AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3175
Mailing Address - Country:US
Mailing Address - Phone:951-735-2700
Mailing Address - Fax:951-256-8255
Practice Address - Street 1:1820 FULLERTON AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3175
Practice Address - Country:US
Practice Address - Phone:951-735-2700
Practice Address - Fax:951-256-8255
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37896208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A378960Medicaid
A28481Medicare UPIN
CA00A378960Medicaid