Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | G62261 | CA |
NPI | 1225061591 |
---|---|
Provider Name | Mahnaz Behboodikhah |
First Address | Newport Beach, CA 92659-5701 |
Second Address | Newport Beach, CA 92663-3680 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 20/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E33335 | (02) | CA |