Provider Demographics
NPI:1730271685
Name:ROUZROCH, SIAMAK (MD)
Entity type:Individual
Prefix:
First Name:SIAMAK
Middle Name:
Last Name:ROUZROCH
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 1:1703 TERMINO AVE
Mailing Address - Street 2:#107
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804
Mailing Address - Country:US
Mailing Address - Phone:562-494-8008
Mailing Address - Fax:562-494-8001
Practice Address - Street 1:1703 TERMINO AVE
Practice Address - Street 2:#107
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804
Practice Address - Country:US
Practice Address - Phone:562-494-8008
Practice Address - Fax:562-494-8001
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72525Medicare PIN
H50508Medicare UPIN