Provider Demographics
NPI:1932758539
Name:MASSOODNIA, ROXANNA (AUD)
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:
Last Name:MASSOODNIA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CAGNEY LN APT 303
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2669
Mailing Address - Country:US
Mailing Address - Phone:760-547-3892
Mailing Address - Fax:
Practice Address - Street 1:18377 BEACH BLVD STE 105
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1349
Practice Address - Country:US
Practice Address - Phone:714-594-3302
Practice Address - Fax:949-561-4484
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3449231H00000X
CA10207237600000X
CAAU3449231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter