Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 5102 | AZ |
Y | 213EG0000X | General Practice | 5102 | AZ |
NPI | 1003834839 |
---|---|
Provider Name | Dr. Leila Hakimzadeh Ghafouri |
First Address | Phoenix, AZ 85018-4763 |
Second Address | Phoenix, AZ 85018-4763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 07/06/2016 |