Provider Demographics
NPI:1184888737
Name:ROUMANI, GHASSAN K (MD)
Entity type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:K
Last Name:ROUMANI
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 1:2110 S OAK KNOLL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1760
Mailing Address - Country:US
Mailing Address - Phone:626-441-0085
Mailing Address - Fax:
Practice Address - Street 1:2110 S OAK KNOLL AVE
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1760
Practice Address - Country:US
Practice Address - Phone:626-441-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAO31429208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology