Provider Demographics
NPI:1215587704
Name:RAISSI ARDALI, MEHRNOUSH
Entity Type:Individual
Prefix:
First Name:MEHRNOUSH
Middle Name:
Last Name:RAISSI ARDALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 TALBERT AVE APT 19
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1320
Mailing Address - Country:US
Mailing Address - Phone:949-662-8969
Mailing Address - Fax:
Practice Address - Street 1:7811 TALBERT AVE APT 19
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1387
Practice Address - Country:US
Practice Address - Phone:949-662-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography