Individual
MARYAM GHOLIZADEH
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1120 W LA VETA AVE, STE. 100, ORANGE, CA 92868-4231
(714) 289-4704
Mailing address
1120 W LA VETA AVE, STE. 100, ORANGE, CA 92868-4231
(714) 289-4704
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
A83935
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A839350
—
CA
Enumeration date
07/18/2005
Last updated
07/08/2007
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