Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 104107 | CA |
Y | 213EG0000X | General Practice | 104107 | CA |
NPI | 1003461872 |
---|---|
Provider Name | Neda Pourrahimi |
First Address | Thousand Oaks, CA 91360-4103 |
Second Address | Thousand Oaks, CA 91360-4103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2019 |
Last Update Date | 12/11/2019 |