Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A75531 | CA |
NPI | 1053426700 |
---|---|
Provider Name | Amir Shahram Makoui |
First Address | Lancaster, CA 93539-4008 |
Second Address | Palmdale, CA 93551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 12/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H46967 | (02) | CA |
OOA755310 | BLUESHIELD (01) | CA |