Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 104088 | CA |
Y | 213EG0000X | General Practice | 104088 | CA |
NPI | 1003466285 |
---|---|
Provider Name | Mina Davar |
First Address | Tarzana, CA 91356-3714 |
Second Address | Tarzana, CA 91356-3714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2019 |
Last Update Date | 18/09/2019 |