MEDICARE: ETESAM MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1164363727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETESAM MD INC

Provider Business Mailing Address
First Line	:	4232 WITHERBY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4232 WITHERBY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1133
Country	:	US
Telephone Number	:	619-797-6746
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ARSHIA ETESAM
Credential	:	M.D.
Telephone Number	:	703-798-3404

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ETESAM MD INC ” Practice Location

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