Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A70958 | CA |
Y | 208600000X | Surgeon | A70958 | CA |
NPI | 1003932740 |
---|---|
Provider Name | Dr. Reza Sadrian |
First Address | La Jolla, CA 92037-1208 |
Second Address | La Jolla, CA 92037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 02/08/2019 |