Healthcare Provider Details

I. General information

NPI: 1962924373
Provider Name (Legal Business Name): MAHDI M SULTANY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MAHDI M SULTANY RN

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-8116
  • Fax: 310-222-8220
Mailing address:
  • Phone: 310-222-2733
  • Fax: 310-222-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX1100X
TaxonomyOphthalmic Registered Nurse
License Number646336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: