Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 125066385 | IL |
Y | 207P00000X | Emergency Physician | A169081 | CA |
N | 2081S0010X | Sports Medicine | 11209646-1205 | UT |
N | 213ES0000X | Sports Medicine | 11209646-1205 | UT |
NPI | 1225427172 |
---|---|
Provider Name | Gabrielle Ahlzadeh |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90017-1901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2015 |
Last Update Date | 05/08/2021 |