Provider Demographics
NPI:1417797408
Name:KARIMZADEH, ROUZBEH (FNP)
Entity type:Individual
Prefix:
First Name:ROUZBEH
Middle Name:
Last Name:KARIMZADEH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S SAN VICENTE BLVD APT 904
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3354
Mailing Address - Country:US
Mailing Address - Phone:510-676-8563
Mailing Address - Fax:
Practice Address - Street 1:830 N FAIRFAX AVE STE 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-7298
Practice Address - Country:US
Practice Address - Phone:323-708-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily