Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 39467 | IA |
N | 2081P2900X | Pain Medicine | 25335 | NY |
N | 2081P2900X | Pain Medicine | 39467 | IA |
Y | 2081P2900X | Pain Medicine | A106279 | CA |
NPI | 1154657716 |
---|---|
Provider Name | Foad Elahi |
First Address | Manteca, CA 95336-5925 |
Second Address | Manteca, CA 95336-5925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2009 |
Last Update Date | 22/06/2015 |