Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | A132575 | CA |
NPI | 1891081253 |
---|---|
Provider Name | Dr. Soorena Fatehchehr |
First Address | Marina Del Rey, CA 90292-5660 |
Second Address | Long Beach, CA 90813-4508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 02/01/2020 |