Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A119827 | CA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A119827 | CA |
NPI | 1316268519 |
---|---|
Provider Name | Dr. Cyrus Emil Taghavi |
First Address | Sacramento, CA 95827-2539 |
Second Address | Davis, CA 95616-6217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 05/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1316268519 | (05) | CA |
A119827 | MEDICAL LICENSE (01) | CA |