Organization Name: | PEYMAN BANOONI MEDICAL GROUP INC. |
NPI Number: | 1093128688 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PEYMAN BANOONI (MEDICAL DIRECTOR) |
Mailing Address: | 6120 Seville Ave Unit B Huntington Park |
State: | CA US |
Postal Code: | 902552911 |
Phone Number: | 3235888855 |
Fax Number: | 3235875474 |
NPI Enumeration Date: | 06/11/2014 |
NPI Last Update Date: | 06/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A75080 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |