Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | A80929 | CA |
NPI | 1326087727 |
---|---|
Provider Name | Dr. Amir Abbas Pouradib |
First Address | Long Beach, CA 90806-1565 |
Second Address | Long Beach, CA 90806-1530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 05/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APPLYING | (05) | CA |
H93147 | (02) | CA |