Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 42736 | CA |
NPI | 1013043876 |
---|---|
Provider Name | Dr. Nooshin Katebzaheh |
First Address | Brea, CA 92821-3373 |
Second Address | Brea, CA 92821-3373 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |