Provider Demographics
NPI:1811978364
Name:AMANI-YAZDI M.D, RAMBOD (MD)
Entity type:Individual
Prefix:MR
First Name:RAMBOD
Middle Name:
Last Name:AMANI-YAZDI M.D
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 1:1330 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:SUITE 206
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70521207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A705210Medicaid
CA00A705210Medicaid