Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A68653 | CA |
NPI | 1063562239 |
---|---|
Provider Name | Ramin Javahery |
First Address | Long Beach, CA 90806-1570 |
Second Address | Long Beach, CA 90806-1570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 23/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A68653 | MEDICAL LICENSE (01) | CA |