Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 32789 | CA |
NPI | 1598187635 |
---|---|
Provider Name | Ida Molayem |
First Address | Los Angeles, CA 90048-5704 |
Second Address | Los Angeles, CA 90048-5704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2014 |
Last Update Date | 08/01/2014 |