Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A121076 | CA |
NPI | 1043444029 |
---|---|
Provider Name | Omid Modarres Mousavi Behbahani |
First Address | Los Angeles, CA 90049-6252 |
Second Address | Downey, CA 90242-2339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2009 |
Last Update Date | 25/09/2015 |