Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A55277 | CA |
NPI | 1023047008 |
---|---|
Provider Name | Katayoun K Mostafaie |
First Address | Torrance, CA 90502-2047 |
Second Address | Torrance, CA 90502-2047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 15/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H42811 | (02) | CA |