Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | A100375 | CA |
Y | 2084N0600X | Clinical Neurophysiologist | A100375 | CA |
NPI | 1073750014 |
---|---|
Provider Name | Dr. Firas Bannout |
First Address | Loma Linda, CA 92354-3450 |
Second Address | Loma Linda, CA 92354-3450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2009 |
Last Update Date | 08/01/2014 |