Individual
JONATHAN TAVAKOLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
11932 GOSHEN AVE PH 1, LOS ANGELES, CA 90049-7309
(310) 651-0098
Mailing address
11932 GOSHEN AVE PH 1, LOS ANGELES, CA 90049-7309
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E5422
CA
Other
Enumeration date
01/22/2018
Last updated
01/22/2018
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