Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 42412 | CA |
NPI | 1073606646 |
---|---|
Provider Name | Mahnaz Rashti |
First Address | Beverly Hills, CA 90212 |
Second Address | Beverly Hills, CA 90212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
227-6158-9 | EDD (01) | CA |