Provider Demographics
NPI:1790989028
Name:AYATOLLAHI, LADAN (CNM, RN, MS)
Entity Type:Individual
Prefix:MRS
First Name:LADAN
Middle Name:
Last Name:AYATOLLAHI
Suffix:
Gender:F
Credentials:CNM, RN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8077 FLORENCE AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3894
Mailing Address - Country:US
Mailing Address - Phone:562-904-6031
Mailing Address - Fax:
Practice Address - Street 1:8077 FLORENCE AVE STE 112
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3894
Practice Address - Country:US
Practice Address - Phone:562-904-6031
Practice Address - Fax:562-904-6033
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001179176B00000X
CA95067203207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No176B00000XOther Service ProvidersMidwife