Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | A122142 | CA |
N | 208D00000X | General Practice Physician | A122142 | CA |
NPI | 1811264807 |
---|---|
Provider Name | Abtin Doroudinia |
First Address | Glendale, CA 91204-1164 |
Second Address | Los Angeles, CA 90033-1370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2011 |
Last Update Date | 17/02/2015 |