Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 43562 | CA |
NPI | 1003097783 |
---|---|
Provider Name | Dr. Mitra Elisha Simanian |
First Address | Manhattan Beach, CA 90266-2470 |
Second Address | Manhattan Beach, CA 90266-2470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2007 |
Last Update Date | 21/11/2007 |