Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | A118311 | CA |
Y | 208D00000X | General Practice Physician | A118311 | CA |
NPI | 1710262472 |
---|---|
Provider Name | Amir H Rad |
First Address | Mission Hills, CA 91346-9602 |
Second Address | Valencia, CA 91355-4488 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2011 |
Last Update Date | 09/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A 118311 | CALIFORNIA MEDICAL BOARD (01) | CA |