Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 49173 | CA |
Y | 1223G0001X | General Practice | 51411 | CA |
Y | 213EG0000X | General Practice | 51411 | CA |
NPI | 1083837181 |
---|---|
Provider Name | Dr. Soheyla Marzvaan |
First Address | Ladera Ranch, CA 92694-2106 |
Second Address | West Covina, CA 91790 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 09/07/2018 |