Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E4318 | CA |
NPI | 1013979822 |
---|---|
Provider Name | Dr. Ali Reza Sadrieh |
First Address | Studio City, CA 91614-0360 |
Second Address | Studio City, CA 91604-2528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 20/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U85754 | (02) | CA |