Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 20A9579 | CA |
Y | 111NI0900X | Internist | 20A9579 | CA |
NPI | 1003039256 |
---|---|
Provider Name | Sohrab Tanavoli |
First Address | Long Beach, CA 90822-5201 |
Second Address | Long Beach, CA 90822-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 06/01/2016 |