Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | HS000084L | PA |
NPI | 1104446475 |
---|---|
Provider Name | Ali Reza Tafreshi |
First Address | Anaheim, CA 92808-1685 |
Second Address | Danville, PA 17822-9800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2020 |
Last Update Date | 01/05/2020 |