Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD045237 | DC |
N | 111NI0900X | Internist | MD045237 | DC |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | A168030 | CA |
NPI | 1003235540 |
---|---|
Provider Name | Sasan Fazeli |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010-3012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2014 |
Last Update Date | 10/12/2020 |