Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 43547 | CA |
NPI | 1073602157 |
---|---|
Provider Name | Dr. Fariba Matinfar |
First Address | Beverly Hills, CA 90213-4521 |
Second Address | Carson, CA 90746-3314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |