Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | C050222 | CA |
NPI | 1518178110 |
---|---|
Provider Name | Fatolah Ferdowsian |
First Address | Anaheim, CA 92808-1664 |
Second Address | Anaheim, CA 92808-1664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 08/07/2007 |