Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 4520 | AZ |
NPI | 1770679797 |
---|---|
Provider Name | Dr. Homan Mostafavi |
First Address | Chandler, AZ 85224-6239 |
Second Address | Chandler, AZ 85224-6239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 18/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201205 | (05) | AZ |