Provider Demographics
NPI:1053893321
Name:ROODBAEI, SADAF
Entity type:Individual
Prefix:
First Name:SADAF
Middle Name:
Last Name:ROODBAEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 GROSVENOR BLVD APT 259
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-7315
Mailing Address - Country:US
Mailing Address - Phone:305-343-1211
Mailing Address - Fax:
Practice Address - Street 1:9171 WILSHIRE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5536
Practice Address - Country:US
Practice Address - Phone:631-327-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist