Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 53905 | CA |
NPI | 1114124989 |
---|---|
Provider Name | Dr. Bahareh Fathi |
First Address | Pasadena, CA 91105-1134 |
Second Address | Studio City, CA 91604-2751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 08/07/2007 |