Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | G83016 | CA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | G83016 | CA |
N | 2086S0105X | Surgery of the Hand | G83016 | CA |
NPI | 1922198092 |
---|---|
Provider Name | M Ramin Modabber |
First Address | Santa Monica, CA 90404-2139 |
Second Address | Santa Monica, CA 90404-2139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 10/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G28940 | (02) | CA |