Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | A96398 | CA |
NPI | 1790809317 |
---|---|
Provider Name | Dr. Gholam Reza Berenji |
First Address | Irvine, CA 92606-8823 |
Second Address | Los Angeles, CA 90073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |