Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | A162777 | CA |
NPI | 1093177073 |
---|---|
Provider Name | Dr. Arek Hidirsah |
First Address | Tarzana, CA 91356-4928 |
Second Address | Los Angeles, CA 90027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 08/09/2020 |