Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 51334 | CA |
Y | 213EG0000X | General Practice | 51334 | CA |
NPI | 1003182619 |
---|---|
Provider Name | Dr. Leyli Dehghan Shirazi |
First Address | Beverly Hills, CA 90210-5016 |
Second Address | Beverly Hills, CA 90210-5016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2012 |
Last Update Date | 28/03/2012 |