Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT24232 | CA |
N | 2251E1200X | Ergonomics | PT24232 | CA |
N | 225XE1200X | Ergonomics | PT24232 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT24232 | CA |
NPI | 1457741316 |
---|---|
Provider Name | Vahid Kabiri |
First Address | Mission Viejo, CA 92692-3406 |
Second Address | Mission Viejo, CA 92692-3406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2015 |
Last Update Date | 30/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT24232 | PT LICENSE (01) | CA |