Basic Information
| Provider Information | |||||||||
| NPI: | 1821693193 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROXANA AMINBAKHSH MD A PROFESSIONAL MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14055 SADDLEBOW DR | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895116747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8589006004 | ||||||||
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| Practice Location | |||||||||
| Address1: | 825 E BIDWELL ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | FOLSOM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956304207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8589006004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2020 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | AMINBAKHSH | ||||||||
| AuthorizedOfficialFirstName: | ROXANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8589006004 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.