Provider Demographics
NPI:1740257609
Name:LANGROUDI, ANDREW REZA (DPM)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:REZA
Last Name:LANGROUDI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 SOLAR DR.
Mailing Address - Street 2:SUITE #102
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036
Mailing Address - Country:US
Mailing Address - Phone:805-988-3338
Mailing Address - Fax:805-830-1537
Practice Address - Street 1:2100 SOLAR DR.
Practice Address - Street 2:SUITE #102
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036
Practice Address - Country:US
Practice Address - Phone:805-988-3338
Practice Address - Fax:805-830-1537
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4469213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU96161Medicare UPIN
CAWE4469BMedicare ID - Type Unspecified