Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A87551 | CA |
Y | 2080A0000X | Adolescent Medicine | A87551 | CA |
NPI | 1295874022 |
---|---|
Provider Name | Edmond Gidon Sarraf |
First Address | Beverly Hills, CA 90213 |
Second Address | Los Angeles, CA 90048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 13/04/2017 |