Provider Demographics
NPI:1427137439
Name:ARMANDI, SOROOSH (DO)
Entity type:Individual
Prefix:
First Name:SOROOSH
Middle Name:
Last Name:ARMANDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1889
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-7889
Mailing Address - Country:US
Mailing Address - Phone:323-726-0533
Mailing Address - Fax:323-726-0274
Practice Address - Street 1:120 S MONTEBELLO BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4730
Practice Address - Country:US
Practice Address - Phone:323-726-0533
Practice Address - Fax:323-726-0274
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477698512Medicaid
CA1477698512Medicaid