Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A41807 | CA |
NPI | 1154370302 |
---|---|
Provider Name | Dr. Nasser Redjal |
First Address | Van Nuys, CA 91405-3605 |
Second Address | Van Nuys, CA 91405-3605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 10/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B50477 | (02) | CA |