Individual
MR. KAMAL EBADPOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13224 IROQUOIS ROAD, APPLE VALLEY, CA 92308
(213) 999-0995
Mailing address
13224 IROQUOIS RD, APPLE VALLEY, CA 92308-6384
(213) 999-0995
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
366426126
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46-2760607
—
CA
Enumeration date
01/05/2015
Last updated
01/05/2015
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