Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G57734 | CA |
NPI | 1003965658 |
---|---|
Provider Name | Kamrooz Tabibzadeh |
First Address | Panorama City, CA 91402-4401 |
Second Address | Panorama City, CA 91402-4401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 10/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G577340 | (05) | CA |
00G577341 | (05) | CA |