MEDICARE: MAHSHID MICHELLE HAMIDI, A MEDICAL CORPORATION

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	261QP2300X	Primary Care Clinic/Center	A63702	CA

General Provider Information

NPI Number	:	1366964488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHSHID MICHELLE HAMIDI, A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	5222 BALBOA AVE STE 31
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6952
Country	:	US
Telephone Number	:	858-565-6394
Fax Number	:	858-605-6719

Provider Business Practice Location Address
First Line	:	5222 BALBOA AVE STE 31
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6952
Country	:	US
Telephone Number	:	858-565-6394
Fax Number	:	858-605-6719

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAHSHID MICHELLE HAMIDI
Credential	:	MD
Telephone Number	:	619-443-0282

Provider Enumeration Date	:	07/11/2017
Last Update Date	:	07/21/2022

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