Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | A102198 | CA |
N | 207VG0400X | Gynecologist | A102198 | CA |
Y | 207VX0000X | Obstetrician | A102198 | CA |
NPI | 1396936217 |
---|---|
Provider Name | Dr. Maryam Ardalan |
First Address | Valencia, CA 91355-2003 |
Second Address | Valencia, CA 91355-3703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 03/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A1021980 | (05) | CA |
0A1021980 | BLUE SHIELD (01) | CA |