Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC 25093 | CA |
NPI | 1588911150 |
---|---|
Provider Name | Marjan Razi Pourdavood |
First Address | Glendale, CA 91203 |
Second Address | Glendale, CA 91203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2012 |
Last Update Date | 13/08/2012 |