Provider Demographics
NPI:1124479332
Name:GHANBARI, RAMEZ
Entity type:Individual
Prefix:
First Name:RAMEZ
Middle Name:
Last Name:GHANBARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 UNIVERSITY AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3272
Mailing Address - Country:US
Mailing Address - Phone:951-200-8575
Mailing Address - Fax:951-530-3997
Practice Address - Street 1:3801 UNIVERSITY AVE STE 270
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3272
Practice Address - Country:US
Practice Address - Phone:951-200-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1714132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry