Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 48609 | CA |
NPI | 1013037266 |
---|---|
Provider Name | Dr. Mahrou - Hazeghi |
First Address | Los Angeles, CA 90071-2101 |
Second Address | Los Angeles, CA 90071-2101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 08/07/2007 |