Provider Demographics
NPI:1134657943
Name:AHMADI, ROOZBEH A (MD)
Entity type:Individual
Prefix:DR
First Name:ROOZBEH
Middle Name:A
Last Name:AHMADI
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:PO BOX 1462
Mailing Address - Street 2:
Mailing Address - City:HUGHSON
Mailing Address - State:CA
Mailing Address - Zip Code:95326-1462
Mailing Address - Country:US
Mailing Address - Phone:209-448-3000
Mailing Address - Fax:209-273-2722
Practice Address - Street 1:1117 W TOKAY ST STE A
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3844
Practice Address - Country:US
Practice Address - Phone:209-484-3000
Practice Address - Fax:209-273-2722
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT8744208100000X, 2081P2900X
CAA166182208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine