Provider Demographics
NPI:1639366941
Name:ROOHBAKHSH MAHER DPM. INC
Entity type:Organization
Organization Name:ROOHBAKHSH MAHER DPM. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROOHBAKHSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-214-9700
Mailing Address - Street 1:2850 ARTESIA BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3419
Mailing Address - Country:US
Mailing Address - Phone:310-214-9700
Mailing Address - Fax:310-214-9790
Practice Address - Street 1:2850 ARTESIA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3419
Practice Address - Country:US
Practice Address - Phone:310-214-9700
Practice Address - Fax:310-214-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4024213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17257Medicaid
CAU61843Medicare UPIN
CAW17257Medicaid
CAW17257Medicare PIN