Provider Demographics
NPI:1205389913
Name:GHOBADPOUR, ROOZBEH (LAC)
Entity type:Individual
Prefix:MR
First Name:ROOZBEH
Middle Name:
Last Name:GHOBADPOUR
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 LEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4829
Mailing Address - Country:US
Mailing Address - Phone:310-990-6433
Mailing Address - Fax:
Practice Address - Street 1:4823 LEDGE AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4829
Practice Address - Country:US
Practice Address - Phone:310-990-6433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17220171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist