Provider Demographics
NPI:1295926087
Name:MASOUD, ROYA (DO)
Entity type:Individual
Prefix:DR
First Name:ROYA
Middle Name:
Last Name:MASOUD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16415 COLORADO AVE 140
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5035
Mailing Address - Country:US
Mailing Address - Phone:562-529-5229
Mailing Address - Fax:562-529-2356
Practice Address - Street 1:16415 COLORADO AVE 410
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5084
Practice Address - Country:US
Practice Address - Phone:562-529-2259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine