Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 21062 | CA |
Y | 213ER0200X | Radiology | 21062 | CA |
NPI | 1255474870 |
---|---|
Provider Name | Arash Mohrdar Ghaemmaghami |
First Address | Riverside, CA 92501-3528 |
Second Address | Riverside, CA 92501-3528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21062 | (02) | CA |