Provider Demographics
NPI:1821693193
Name:ROXANA AMINBAKHSH MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ROXANA AMINBAKHSH MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINBAKHSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-900-6004
Mailing Address - Street 1:14055 SADDLEBOW DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-6747
Mailing Address - Country:US
Mailing Address - Phone:858-900-6004
Mailing Address - Fax:
Practice Address - Street 1:825 E BIDWELL ST STE 400
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4207
Practice Address - Country:US
Practice Address - Phone:858-900-6004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty