Healthcare Provider Details

I. General information

NPI: 1417070087
Provider Name (Legal Business Name): MAHTAB PARTOVI D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 05/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 WESTWOOD BLVD # 305
LOS ANGELES CA
90024-5620
US

IV. Provider business mailing address

1575 WESTWOOD BLVD # 305
LOS ANGELES CA
90024-5620
US

V. Phone/Fax

Practice location:
  • Phone: 310-663-2292
  • Fax:
Mailing address:
  • Phone: 310-663-2923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number54424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: