Healthcare Provider Details

I. General information

NPI: 1013146745
Provider Name (Legal Business Name): SAMIRA GOLPARYANI RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 S VERMONT AVE SUITE F
LOS ANGELES CA
90007-2298
US

IV. Provider business mailing address

1377 S BEVERLY GLEN BLVD APT# 607
LOS ANGELES CA
90024-5214
US

V. Phone/Fax

Practice location:
  • Phone: 323-731-3333
  • Fax:
Mailing address:
  • Phone: 718-216-3690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number24293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: