Provider Demographics
NPI:1841579489
Name:ROUHANI SISAN, MEHRAN (MD)
Entity Type:Individual
Prefix:
First Name:MEHRAN
Middle Name:
Last Name:ROUHANI SISAN
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 1:501 S IDAHO ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6047
Mailing Address - Country:US
Mailing Address - Phone:562-501-1720
Mailing Address - Fax:562-501-1198
Practice Address - Street 1:501 S IDAHO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6047
Practice Address - Country:US
Practice Address - Phone:562-690-0400
Practice Address - Fax:562-501-1198
Is Sole Proprietor?:No
Enumeration Date:2011-08-14
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine