Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | A30009 | CA |
NPI | 1437346244 |
---|---|
Provider Name | Dr. Mohammed Izhar |
First Address | Los Angeles, CA 90025-3303 |
Second Address | Los Angeles, CA 90025-3303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2007 |
Last Update Date | 14/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A300090 | (05) | CA |
B18219 | (02) | CA |
RHL 131454 | X-RAY SUPERVISOR / OPERAT (01) |