Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | C39780 | CA |
NPI | 1033140934 |
---|---|
Provider Name | Mahmood Mahdavi |
First Address | La Jolla, CA 92037-1224 |
Second Address | La Jolla, CA 92037-1224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A37219 | (02) |