Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC24280 | CA |
NPI | 1235200668 |
---|---|
Provider Name | Dr. Ali Reza Bamdad |
First Address | South San Francisco, CA 94080-5966 |
Second Address | South San Francisco, CA 94080-5966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 23/02/2015 |