Individual
REZA FARDANESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
757 WESTWOOD PLZ, LOS ANGELES, CA 90095-3725
(310) 301-6800
(310) 794-9035
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
(310) 301-5138
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
286765
NY
2085R0202X
Diagnostic Radiology Physician
Primary
A172279
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04698564
—
NY
Enumeration date
06/12/2008
Last updated
12/21/2021
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