Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 36508 | CA |
NPI | 1891987913 |
---|---|
Provider Name | Dr. Mahvash Navazesh |
First Address | Los Angeles, CA 90089-0641 |
Second Address | Los Angeles, CA 90089-0641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 05/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G1011701 | (05) | CA |
U0100701 | (05) | CA |
U96923 | (02) | CA |
ZZZ34010Z | BLUE CROSS/BLUE SHIELD (01) | CA |