Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | A72759 | CA |
NPI | 1780773721 |
---|---|
Provider Name | Dr. Hma Mahdavi |
First Address | Cypress, CA 90630-3966 |
Second Address | Long Beach, CA 90804-2169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A727590 | (02) | CA |