Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | A83935 | CA |
NPI | 1194724583 |
---|---|
Provider Name | Maryam Gholizadeh |
First Address | Orange, CA 92868-4231 |
Second Address | Orange, CA 92868-4231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A839350 | (05) | CA |
H70577 | (02) |