Provider Demographics
NPI:1689120586
Name:MARYAM SEDDIGH TONEKABONI, MD, INC.
Entity Type:Organization
Organization Name:MARYAM SEDDIGH TONEKABONI, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDDIGH TONEKABONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-274-4358
Mailing Address - Street 1:18350 ROSCOE BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4159
Mailing Address - Country:US
Mailing Address - Phone:818-671-1989
Mailing Address - Fax:818-698-0440
Practice Address - Street 1:18350 ROSCOE BLVD STE 307
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4159
Practice Address - Country:US
Practice Address - Phone:818-671-1989
Practice Address - Fax:818-698-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851663744OtherINDIVIDUAL NPI
CA1689120586OtherNPI GROUP
CA1851663744OtherINDIVIDUAL NPI