Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 61053 | CA |
NPI | 1174892673 |
---|---|
Provider Name | Anita Tourah |
First Address | Marina Del Rey, CA 90292-6014 |
Second Address | Santa Monica, CA 90404-1811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2011 |
Last Update Date | 29/12/2011 |