Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A87582 | CA |
N | 2080P0204X | Pediatric Emergency Doctor | A87582 | CA |
NPI | 1154461051 |
---|---|
Provider Name | Dr. Menouchehr Bazyani |
First Address | Lake Elsinore, CA 92530-7006 |
Second Address | Lake Elsinore, CA 92530-7006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A875820 | (05) | CA |