Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 28774 | TX |
Y | 122300000X | Dentist | 57464 | CA |
N | 1223D0004X | Dentist Anesthesiologist | 1535 | CA |
N | 1223G0001X | General Practice | 28774 | TX |
N | 213EG0000X | General Practice | 28774 | TX |
NPI | 1619126943 |
---|---|
Provider Name | Dr. Negar Boloorchi |
First Address | San Marino, CA 91108-1404 |
Second Address | Walnut Creek, CA 94596-8606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2008 |
Last Update Date | 12/09/2021 |