Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618002324 | VA |
NPI | 1013323500 |
---|---|
Provider Name | Houriya Mahboobi |
First Address | Baltimore, MD 21297-1334 |
Second Address | Salem, VA 24153-6404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2014 |
Last Update Date | 18/05/2015 |