Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | R1690 | AZ |
N | 111NI0900X | Internist | R1690 | AZ |
Y | 2084N0400X | Neurologist | 2012737 | CA |
N | 2084N0400X | Neurologist | 20A12737 | CA |
N | 2084N0400X | Neurologist | A-2202-18 | NM |
NPI | 1013143619 |
---|---|
Provider Name | Dr. Forough Sadat Ghavami Shirehjini |
First Address | Coto De Caza, CA 92679-5206 |
Second Address | Coto De Caza, CA 92679-5206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 20/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A-2202-18 | NEW MEXICO MEDICAL LICENSE (01) | NM |