Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | A71799 | CA |
NPI | 1013022615 |
---|---|
Provider Name | Alborz Hassankhani |
First Address | La Mesa, CA 91943-2187 |
Second Address | La Mesa, CA 91942-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 20/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A717990 | (05) | CA |
I04699 | (02) |