Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A122793 | CA |
N | 2080P0203X | Pediatric Critical Care Doctor | 21107 | NV |
NPI | 1245599687 |
---|---|
Provider Name | Ali Javod Sheikhizadeh |
First Address | Redondo Beach, CA 90277-4058 |
Second Address | Los Angeles, CA 90027-6082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2012 |
Last Update Date | 24/01/2022 |