MEDICARE: DR. SAEIDEH TORABI DALIVANDAN PHD, CGMBS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1447955596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAEIDEH TORABI DALIVANDAN PHD, CGMBS

Provider Business Mailing Address
First Line	:	757 WESTWOOD PLZ
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-7419
Country	:	US
Telephone Number	:	310-206-5008
Fax Number	:	310-794-3574

Provider Business Practice Location Address
First Line	:	658 W LEXINGTON DR
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1662
Country	:	US
Telephone Number	:	818-299-2684
Fax Number	:

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

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	03/30/2023

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