Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E5332 | CA |
N | 213ES0103X | Foot & Ankle Surgery | E5332 | CA |
NPI | 1164824249 |
---|---|
Provider Name | Ali Ghorbanifarajzadeh |
First Address | Bakersfield, CA 93311-8854 |
Second Address | Bakersfield, CA 93311-9505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2014 |
Last Update Date | 06/08/2019 |