Provider Demographics
NPI:1497736334
Name:AMIRNOVIN, RAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:
Last Name:AMIRNOVIN
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 1:255 EAST BONITA AVENUE BUILDING #9
Mailing Address - Street 2:LDR NEUROSURGERY
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767
Mailing Address - Country:US
Mailing Address - Phone:909-450-0369
Mailing Address - Fax:909-450-0366
Practice Address - Street 1:255 EAST BONITA AVENUE BUILDING #9
Practice Address - Street 2:LDR NEUROSURGERY
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-450-0369
Practice Address - Fax:909-450-0366
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98619207T00000X
MA213866207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0099730Medicaid
CA00A986190Medicaid
CA00A986190Medicare PIN
CAZZZ07226ZMedicare PIN
CAWA98619AMedicare PIN
CA00A986190Medicaid