Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | MA061459 | PA |
NPI | 1093340424 |
---|---|
Provider Name | Nusheen Goshtasbi |
First Address | Costa Mesa, CA 92627-1562 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2020 |
Last Update Date | 05/03/2020 |