Provider Demographics
NPI:1063562239
Name:JAVAHERY, RAMIN (MD)
Entity type:Individual
Prefix:
First Name:RAMIN
Middle Name:
Last Name:JAVAHERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2888 LONG BEACH BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1570
Mailing Address - Country:US
Mailing Address - Phone:562-595-7696
Mailing Address - Fax:562-490-3846
Practice Address - Street 1:2888 LONG BEACH BLVD STE 240
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1570
Practice Address - Country:US
Practice Address - Phone:562-595-7696
Practice Address - Fax:562-490-3846
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA68653207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA68653OtherMEDICAL LICENSE