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SAN JUDAS MEDICAL GROUP WEST NPI 1033256573


NPI Information

NPI: 1033256573
Provider Name: SAN JUDAS MEDICAL GROUP WEST

Doing Business As: N. ROSTAMI MEDICAL GROUP, INC.

Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 05D0910778

Address:
1080 N WESTERN AVE
LOS ANGELES, CA
ZIP 90029
Phone: (323) 957-8787
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SAN JUDAS MEDICAL GROUP WEST is a specialist in Los Angeles, CA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. SAN JUDAS MEDICAL GROUP WEST NPI is 1033256573. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As N. Rostami Medical Group, Inc..

The provider's business location address is:

1080 N WESTERN AVE
LOS ANGELES, CA
ZIP 90029-310
Phone: (323) 957-8787
Fax: (323) 957-8777

The provider's authorized official is Nejat Rostami .
The authorized official title is Medical Director and has the following contact phone number (323) 957-8787.

The CLIA number assigned to this NPI record is 05D0910778 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/1/2007 and was last updated on 9/22/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistA48731CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1GR0067430MEDICAIDCALIFORNIA
2W13920MEDICARE ID-TYPE UNSPECIFIEDCALIFORNIAMEDICARE GROUP PROVIDER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.