Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A165276 | CA |
Y | 111NI0900X | Internist | A165276 | CA |
NPI | 1003341116 |
---|---|
Provider Name | Atheer A Razzouk |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-8358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2017 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A165276 | STATE LICENSE (01) | CA |
FR8988137 | DEA (01) | CA |