Basic Information
| Provider Information | |||||||||
| NPI: | 1568442986 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DJODEIR | ||||||||
| FirstName: | MASOOMEH | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2925 NORTH PALO VERDE AVE. | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624292473 | ||||||||
| FaxNumber: | 5624965577 | ||||||||
| Practice Location | |||||||||
| Address1: | 2925 NORTH PALO VERDE AVE. | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624292473 | ||||||||
| FaxNumber: | 5624965577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 02/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | E-4151 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 05070016600 | 01 | AR | QUAL CHOICE | OTHER | 2563342 | 01 | AR | UNITED HEALTH CARE | OTHER | 157173001 | 05 | AR | MEDICAID | 7484660 | 01 | AR | AETNA | OTHER | 5652522 | 01 | AR | FIRST HEALTH | OTHER | 5N077 | 01 | AR | BCBS | OTHER |