Provider Demographics
NPI:1912192014
Name:GHASEMLOEI, HOMA (MD)
Entity Type:Individual
Prefix:DR
First Name:HOMA
Middle Name:
Last Name:GHASEMLOEI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4204
Mailing Address - Country:US
Mailing Address - Phone:818-996-4888
Mailing Address - Fax:818-996-5888
Practice Address - Street 1:6830 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4204
Practice Address - Country:US
Practice Address - Phone:818-996-4888
Practice Address - Fax:818-996-5888
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine