Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | A97751 | CA |
N | 225100000X | Physical Therapist | PT 12456 | CA |
NPI | 1003991431 |
---|---|
Provider Name | Aliasghar Matin |
First Address | Glendale, CA 91208-2416 |
Second Address | North Hollywood, CA 91601-2104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 29/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
170185 | (02) | CA |