Provider Demographics
NPI:1720164551
Name:RAMBOD AMANI YAZDI MD CORP
Entity Type:Organization
Organization Name:RAMBOD AMANI YAZDI MD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMBOD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMANI YAZDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-267-9138
Mailing Address - Street 1:1330 W COVINA BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3200
Mailing Address - Country:US
Mailing Address - Phone:909-267-9138
Mailing Address - Fax:909-267-9566
Practice Address - Street 1:1330 W COVINA BLVD
Practice Address - Street 2:SUITE206
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3200
Practice Address - Country:US
Practice Address - Phone:909-267-9138
Practice Address - Fax:909-267-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A70521207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A705210Medicaid
CA00A705210Medicaid
H17431Medicare UPIN