Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 111955 | CA |
NPI | 1295998300 |
---|---|
Provider Name | Dr. Reza Kermani |
First Address | Pasadena, CA 91105-3418 |
Second Address | Mission Hills, CA 91345-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 08/09/2016 |