Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A55006 | CA |
NPI | 1174546071 |
---|---|
Provider Name | Elham Ghadishah |
First Address | Los Angeles, CA 90024-4522 |
Second Address | Culver City, CA 90232-2751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 31/03/2021 |