Provider Demographics
NPI:1932496700
Name:SONBOLIAN, FERESHTEH ANGELA
Entity Type:Individual
Prefix:
First Name:FERESHTEH
Middle Name:ANGELA
Last Name:SONBOLIAN
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 1:6507 MOORE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5325
Mailing Address - Country:US
Mailing Address - Phone:310-402-1449
Mailing Address - Fax:
Practice Address - Street 1:6507 MOORE DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5325
Practice Address - Country:US
Practice Address - Phone:310-402-1449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist