MEDICARE: MEHRNOUSH RAISSI ARDALI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246XS1301X	Sonography Specialist/Technologist Cardiovascular

General Provider Information

NPI Number	:	1215587704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEHRNOUSH RAISSI ARDALI

Provider Business Mailing Address
First Line	:	7711 TALBERT AVE APT 19
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-1320
Country	:	US
Telephone Number	:	949-662-8969
Fax Number	:

Provider Business Practice Location Address
First Line	:	7811 TALBERT AVE APT 19
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-1387
Country	:	US
Telephone Number	:	949-662-8969
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	09/16/2019

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