Provider Demographics
NPI:1992898845
Name:BROOMAND, BEHROUZ (MD)
Entity type:Individual
Prefix:
First Name:BEHROUZ
Middle Name:
Last Name:BROOMAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6056 LANKERSHIM BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4806
Mailing Address - Country:US
Mailing Address - Phone:818-761-2300
Mailing Address - Fax:818-761-5066
Practice Address - Street 1:6056 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4806
Practice Address - Country:US
Practice Address - Phone:818-761-2300
Practice Address - Fax:818-761-5066
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043704208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A437040Medicaid