Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 300341 | CA |
Y | 213ES0000X | Sports Medicine | 300341 | CA |
NPI | 1063084093 |
---|---|
Provider Name | Abtin Anvari |
First Address | Huntington Beach, CA 92647-3568 |
Second Address | Huntington Beach, CA 92647-3568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2021 |
Last Update Date | 09/07/2021 |