Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A94111 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A94111 | CA |
NPI | 1285740811 |
---|---|
Provider Name | Masoud Ghalambor |
First Address | Sacramento, CA 95816-5119 |
Second Address | Sacramento, CA 95816-5119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I26763 | (02) | CA |
ZZZ00355Z | BLUE SHIELD OF CALIF. (01) | CA |